Measuring brain potentials of imagination linked to physiological needs and motivational states.

Introduction: While EEG signals reflecting motor and perceptual imagery are effectively used in brain computer interface (BCI) contexts, little is known about possible indices of motivational states. In the present study, electrophysiological markers of imagined motivational states, such as craves and desires were investigated. Methods: Event-related potentials (ERPs) were recorded in 31 participants during perception and imagery elicited by the presentation of 360 pictograms. Twelve micro-categories of needs, subdivided into four macro-categories, were considered as most relevant for a possible BCI usage, namely: primary visceral needs (e.g., hunger, linked to desire of food); somatosensory thermal and pain sensations (e.g., cold, linked to desire of warm), affective states (e.g., fear: linked to desire of reassurance) and secondary needs (e.g., desire to exercise or listen to music). Anterior N400 and centroparietal late positive potential (LPP) were measured and statistically analyzed. Results: N400 and LPP were differentially sensitive to the various volition stats, depending on their sensory, emotional and motivational poignancy. N400 was larger to imagined positive appetitive states (e.g., play, cheerfulness) than negative ones (sadness or fear). In addition, N400 was of greater amplitude during imagery of thermal and nociceptive sensations than other motivational or visceral states. Source reconstruction of electromagnetic dipoles showed the activation of sensorimotor areas and cerebellum for movement imagery, and of auditory and superior frontal areas for music imagery. Discussion: Overall, ERPs were smaller and more anteriorly distributed during imagery than perception, but showed some similarity in terms of lateralization, distribution, and category response, thus indicating some overlap in neural processing, as also demonstrated by correlation analyses. In general, anterior frontal N400 provided clear markers of subjects' physiological needs and motivational states, especially cold, pain, and fear (but also sadness, the urgency to move, etc.), than can signal life-threatening conditions. It is concluded that ERP markers might potentially allow the reconstruction of mental representations related to various motivational states through BCI systems.

Surgical management of acquired non-malignant tracheo-esophageal fistulas.

BACKGROUND: The aim of this study was to evaluate the results of one-stage surgical management of acquired non-malignant tracheo-esophageal fistulas (TEF). METHODS: Six consecutive patients, 2 men and 4 women with median age of 65 (range 34-71) years had tracheo-esophageal fistulas resulting from a median of 33 (range 20-86) days of intubation via oro-tracheal or tracheostomy tubes. Median TEF length was 2.6 (range 1.8-3.5) cm and the defect was associated with a tracheal stenosis near or immediately below the stoma in 4 cases (66%). Tracheal resection and anastomosis with primary esophageal closure was carried out in 4 patients; direct closure of the tracheal and esophageal defects with muscle flap interposition was performed in 2 patients: tracheal stoma was left in site because of the high risk of postoperative respiratory insufficiency related to chronic obstructive pulmonary disease. RESULTS: All six patients had complete control of the TEF. One perioperative death occurred on day 27 (16%) related to the recurrence of endocranial bleeding. The 5 long-term survivors were routinely submitted to tracheo-bronchoscopic control and only one (20%) revealed granulation tissue at the suture line requiring two consecutive bronchoscopic removals. CONCLUSIONS: Postintubation tracheoesophageal fistula is usually best treated with one-stage surgical procedure: which preferably consists of tracheal resection and anastomosis and primary esophageal closure.

Postoperative pain and superficial abdominal reflexes after posterolateral thoracotomy.

BACKGROUND: Posterolateral thoracotomy can produce stretching of/or damage to the intercostal nerves and their branches. To assess intercostal nerve impairment after operation, we measured the superficial abdominal reflexes, which are mediated, at least in part, by the most inferior intercostal nerves. METHODS: Using electrophysiologic techniques, we made recordings from the left and right abdominal walls to study the responses evoked by mechanical stimulation of the skin after operation. In addition, we assessed postoperative pain intensity according to a numeric rating scale and recorded postoperative opioid dose. RESULTS: We found that the patients with complete disappearance of the superficial abdominal reflexes experienced more severe postoperative pain than those in whom the reflexes were maintained. Moreover, opioid treatment was less effective in the patients with no reflexes postoperatively. CONCLUSIONS: Our findings show a strict correlation between pain intensity after posterolateral thoracotomy and absence of abdominal reflexes. We suggest that the higher pain intensity together with the absence of reflexes may be due to intercostal nerve impairment, be it anatomic or functional, and thus to a larger neuropathic component of postoperative pain. This finding may be used as a predictor of patients with high analgesic requirements.

[Mediastinal Castleman's disease]. / Malattia di Castleman a localizzazione mediastinica.

Castleman's disease(CD) is an uncommon lymph node syndrome, generally located in mediastinum side, rarely systemic. Two histhologic types are described: the more common, termed the hyaline-vascular type, generally asymptomatic, and the second termed plasma cell type, with systemic manifestations of the disease, like fever, anemia and weight loss. The authors present a case of a young man with Castleman's disease, treated by prednisone without reduction of the adenopathy, and thus successfully operated, and discuss about aetiopathogenic theories and treatment of this disease.

[Benign fibrous mesothelioma of the pleura]. / Il mesotelioma fibroso benigno della pleura.

The authors report 4 cases of patients with benign fibrous mesothelioma of the pleura, an extremely rare pathology (not more than 500 cases reported to date in the literature), and discuss biological behaviour, diagnosis and surgical treatment. Benign fibrous mesothelioma is generally diagnosed by chance during chest x-ray given that it is paucisymptomatic; diagnostic procedures include thoracic CT (which may be supplemented by transthoracic needle biopsy) and bronchoscopy. Treatment is surgical and consists of exeresis of the neoplasia; prognosis is excellent and cases are reported in the literature of 24-year follow-up without recurrence. Lastly, the authors underline the importance of modern immunohistochemical techniques which help the surgeon to formulate a precise diagnosis and to differentiate benign fibrous mesothelioma.

[Askin's tumor in a young adult: a rare occurrence. Apropos one case observed]. / Il tumore di Askin in un giovane adulto: una rara evenienza. A proposito di un caso osservato.

Askin's tumour is a rare malignant small cell neoplasia of the thoracic wall; it most often effects females during childhood and is characterised by limited survival. The authors report a recent case of Askin's tumour in a young adult male. The case was characterised by multiple recidivation but a long survival. The authors discuss its diagnosis and treatment.

Bronchial sleeve resection distal to the main bronchi with complete pulmonary preservation. Report on three successful cases.

Three successful cases of low grade malignant bronchial tumors resected by means of a bronchial sleeve resection distal to the main bronchi with complete pulmonary preservation are presented. Reconstruction of the bronchial tree was accomplished by suturing together the distal lobar bronchi and then anastomosing the double-barrel suture to the proximal residual bronchus. All patients presented excellent results, although in one patient postoperative course was complicated by persistent mucopurulent secretions. Bronchial sleeve resection distal to the main bronchi can be successfully performed for benign or low-grade malignant bronchial tumors. Technically, the operation is more complex than standard sleeve resection of the main bronchus and requires an experienced team. Postoperatively, an increased morbidity rate, mostly represented by secretions retention, may usually be anticipated, necessitating an aggressive medical and bronchoscopic management.

Combined radiosurgical treatment of Pancoast tumor.

Operative technique and long-term results of 60 consecutive patients with Pancoast tumor treated with combined radiosurgical treatment were evaluated. External radiation therapy was administered preoperatively in a dose of 30 Gy in 50 patients. Operation was considered radical (R0) in 36 patients (60%). A microscopic invasion of the margin of resection (R1) was observed in 5 patients (8.3%). In 19 patients (31.6%) the operation was considered presumably not radical (R2). Three patients died in the postoperative period (5%). Fourteen major postoperative complications occurred in 13 patients (21%). Seven patients had recurrence of pain postoperatively. Overall 3- and 5-year actuarial survival rates were 34% and 17.4%, respectively. The corresponding figures for the R0 and combined R1-R2 groups were 45.8% and 23.5% (R0), and 11.4% (R1-R2; no 5-year survivors were observed in this group) (p < 0.025). Median survivals in the R0 and combined R1-R2 patients were 19 and 7 months, respectively. Different median survivals for the patients with residual tumor were as follows: intervertebral foramina, 5 months; subclavian artery (isolated), 9 months; subclavian artery (in association), 7 months; brachial plexus, 4 months; and vertebral body, 7 months. We conclude that combined radiosurgical treatment represents a valuable therapeutic option in the treatment of Pancoast tumor. In case of residual tumor a poor outcome may usually be anticipated, but in the majority of these patients the operation permits good control of the pain.

Bronchoplastic and angioplastic techniques in the treatment of bronchogenic carcinoma.

From 1979 to 1991, 51 bronchoplasties, 18 angioplasties, and 4 combined broncho-angioplasties were performed for bronchogenic carcinoma. Sixteen patients underwent operation because of compromised pulmonary function; bronchoplasty, angioplasty, or the combined procedure was performed in the remaining 57 patients because of a suitable anatomic location of the neoplasm. Twenty-four patients had stage I disease, 32 stage II, and 17 stage IIIa. Three patients died postoperatively (3.65%). Major postoperative complications occurred in 20 patients (27.3%) (10 early, and 10 late). A completion pneumonectomy was required in 4 patients (5.4%), 2 for anastomotic stricture, 1 because of vascular thrombosis after angioplasty, and 1 for local recurrence after angioplasty. Three-year and 5-year survival rates for the entire group were 55.4% and 40.8%, respectively. One-year and 3-year survival rates after angioplasty were 78.6% and 31.4%. Of the 4 patients who underwent a combined bronchoangioplastic procedure, 1 died after 23 months and 3 are alive and well after 11, 15, and 20 months. Survival was more favorable in the combined N0-N1 group (62% and 43.1%) than in the N2 group (23.4%), but the difference was not significant (p < 0.2). Three-year survival after angioplasty was found to be lower than, although not significantly different from, the overall 3-year survival rate (31.4% versus 55.4%; p = not significant). No statistically significant differences were found among survival rates of patients with compromised and noncompromised pulmonary reserve. We conclude that bronchoplastic and angioplastic procedures are valid techniques as curative operations in carefully selected patients with bronchogenic carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)

[Post-traumatic hernia of the diaphragm]. / Le ernie post-traumatiche del diaframma.

The paper reports the series of post-traumatic hernias of the diaphragm observed during the period between 1954 and June 1992. This group of 77 patients (59 males and 18 females) were aged between 6 and 75 years old. Both acute and chronic hernias were reported; in 60 cases the diaphragmatic lesion was on the left, in 9 cases on the right, and there were 8 cases of laceration to both hemidiaphragms. The most frequently herniated organ was the stomach, followed by the transverse colon and spleen. With regard to the access route used, the authors draw attention to the fact that during the first twenty years of the series thoracotomies were prevalently used, whereas during the last decade laparotomy has been used in cases of early post-traumatic hernia, thoracotomy in cases of chronic post-traumatic hernia or if there is suspected damage to organs and intrathoracic structures.

Defective T-cell activation by Mycoplasma arthritidis mitogen is restored by interferon-gamma.

A mitogen derived from supernatants of Mycoplasma arthritidis (MAS) has been shown to induce both T-cell activation and the production of interferon-gamma (IFN-gamma). MAS-induced response required the presence of accessory cells and is under the genetic control associated with the major histocompatibility complex (MHC). We found that recombinant IFN-gamma restored the proliferative response to MAS mitogen in unreactive mice strains, including H-2b and H-2s haplotypes. We postulated that these T-cells fail to respond since they lack part of the I-E molecules on their accessory cells. Our data suggest that interferon-gamma may be able not only to increase the levels of Ia antigens but also to promote the appearance of MHC products that are not usually present on the cell surface. Since Ia antigens have a central role on T-cell activation, we examined the effect of the level of IFN-gamma on MAS-induced T-cell activation. We analyzed the acquisition of responsiveness to IL-2 and IL-2 activity in cells pretreated with IFN-gamma and found that both the steps of T-cell activation were restored to the MAS mitogen in the unreactive mice strains by IFN-gamma.

Effect of lung resection on pulmonary function. A comparative study in different surgical procedures.

The effect of lung surgery on respiratory function has been investigated in 40 patients considering separately the three main procedures (pneumonectomy, lobectomy and thoracotomy alone) to ascertain if the resected lung and the volume removal can influence this function in the immediate postoperative period. The patients were submitted to spirometry and arterial gas analysis preoperatively and during 9 days postoperation; the tests controlled were VC, FEV1, TV and RR. No significant difference has been noticed among various surgical procedures.

[Neuron-specific enolase: a new marker for small-cell pulmonary carcinoma]. / Enolasi neurono-specifica: nuovo marker per il carcinoma polmonare "small-cell".

A marker of neuroendocrine differentiation, neuron-specific enolase (NSE) is assessed in the diagnosis of small cell lung cancer (SCLC). The market was found to be highly sensitive and extremely specific in high risk groups (smokers and chronic bronchitics).

The role of gamma interferon in B-cell activation.

This study evaluates the role of gamma interferon in in vitro B-cell activation. Two clones of an alloreactive helper T-cell line were equally effective in activating B cells polyclonally to proliferate and to mature to immunoglobulin secretion. One of these clones produced high levels of gamma interferon, while the other clone did not. From these data we conclude that gamma interferon plays no limiting role in T-dependent B-cell activation.

[Pathological and clinical aspects of bronchial carcinoid tumor. The authors' own case reports]. / Aspetti patologici e clinici del tumore carcinoide bronchiale. Casistica personale.

Data (radiological, endoscopic, histological, clinical and surgical) are presented on 21 subjects with pulmonary carcinoid tumour encountered in the Turin University Chest Surgery Centre in 1980-1985. All patients were subjected to fibrobronchoscopy which revealed the tumour in 18 cases (14 were given multiple biopsies and in 4 cases samples could not be taken due to the patient's intolerance of the endoscopic manoeuvre). No appreciable bleeding occurred after any biopsy. Surgery was performed on all 21 patients (2 pneumonectomies, 7 bilobectomies, 12 lobectomies). There was 85.71% correspondence between pre and post-operative histological diagnosis.