KTP laser therapy for bleeding from chronic radiation proctopathy.

BACKGROUND: Endoscopic laser photocoagulation is commonly used to treat bleeding from the neovascular lesions of chronic radiation proctopathy. The KTP laser is an Nd/YAG-driven unit that emits light with a wavelength of 532 nm. This wavelength of energy is absorbed by hemoglobin and penetrates tissue to a depth of only 1 to 2 mm. METHODS: Twenty-three patients were treated with KTP laser and followed for a median of 29 months (range 5 to 51 months); 21 had received radiation for prostate cancer and 2 for uterine cancer. The median age was 77 years (range 68 to 87 years). A median of 2 sessions (range 1 to 5 sessions) was performed using 4 to 10 Watts of power and a median energy of 816 Joules per session (range 204 to 2430 Joules). RESULTS: After treatment there was a significant reduction in the frequency (p = 0.0005) of bleeding, increase in hematocrit level (p < 0.0001), improvement in activities of daily life (p = 0.01), and a reduction in use of health care resources (p < 0.0001). There was a trend toward decreased use of iron supplements (11 to 4 patients) and transfusions (4 to 0 patients). Two patients (9%) developed rectal ulcers after treatment. CONCLUSIONS: KTP laser photocoagulation is a safe and effective therapy for bleeding from chronic radiation proctopathy that improves activities of daily living and reduces use of health care resources.

Analysis of recurrent cortico-basal ganglia-thalamic loops for working memory.

We analyse a simplified form of the frontal lobe architecture of cortico-basal ganglia-thalamo-cortical loops to determine the manner in which they can learn temporal sequences as part of working memory activity. In particular, we consider how the temporal duration of activity can arise in this setting. We start from a hard-wired version in which temporally extended activity is created by the 'long' loop of cortex --> basal ganglia --> thalamus --> cortex, and show it arises from a near saddle-node bifurcation. The manner in which the transition between patterns occurs is also considered. This is then extended to analyse the temporal sequence storage and regeneration abilities of trained networks with a similar architecture. The temporal dynamics of this activity is also analysed. Implications of this for other working memory activities and for understanding the architecture of the frontal lobes are discussed in conclusion.

Mathematical analysis of lead field expansions.

The solution to the bioelectromagnetic inverse problem is discussed in terms of a generalized lead field expansion, extended to weights depending polynomially on the current strength. The expansion coefficients are obtained from the resulting system of equations which relate the lead field expansion to the data. The framework supports a family of algorithms which include the class of minimum norm solutions and those of weighted minimum norm, including FOCUSS (suitably modified to conform to requirements of rotational invariance). The weighted-minimum-norm family is discussed in some detail, making explicit the dependence (or independence) of the weighting scheme on the modulus of the unknown current density vector. For all but the linear case, and with a single power in the weight, a highly nonlinear system of equations results. These are analyzed and their solution reduced to tractable problems for a finite number of degrees of freedom. In the simplest magnetic field tomography (MFT) case, this is shown to possess expected properties for localized distributed sources. A sensitivity analysis supports this conclusion.

Observation of quantization effects in human auditory cortex.

Auditory evoked magnetic fields were recorded from five human subjects using the BTi whole head system (148 channels). The stimuli were simple tone bursts with different inter-stimulus intervals (ISI). The magnetic field was also recorded from the same subjects in place without stimulation to provide baseline 'noise' measurements. Magnetic field tomography (MFT) was applied to the average data and activation curves were computed from well circumscribed regions of interest (ROI). Objective statistical measures (Kolmogorov-Smirnov test) were then used to identify latency segments with distribution significantly different from the baseline distribution. For latency segments with significant activations the dependence of the activation strength on ISI was modeled by an exponentially saturating function. In earlier studies, the characteristic time (tau) in this function was interpreted as a measure of a memory trace for auditory tones. Our analysis identified distinct levels for tau: all subjects had the same lower two levels (0.50 s and 0.69 s). Attention modulation introduced considerably higher tau values in most subjects but it did not change the two 'ground state' tau levels. To our knowledge, this is the first demonstration of quantization effects in the macro-properties of brain activity, which were universal amongst the subjects we studied.

A three stage model of awareness: formulation and initial experimental support.

The various components which together make up the complex state of consciousness require neural support involving a connected network of many brain areas at differing levels. At the lowest level is non-aware processing, of which there is not direct awareness. There are also modules involved in processing with awareness but without focussed attention. Finally there must be a set of modules involved in directing attention in a controlled manner. We expect to be able to dissociate the various components of the three-stage network by using different levels of attention. The results of an auditory experiment performed under three different levels of awareness and attention are analysed to show support for the three-stage model of awareness. The relevant auditory areas are delineated.

A global competitive neural network.

A study is presented of a set of coupled nets proposed to function as a global competitive network. One net, of hidden nodes, is composed solely of inhibitory neurons and is excitatorily driven and feeds back in a disinhibitory manner to an input net which itself feeds excitatorily to a (cortical) output net. The manner in which the former input and hidden inhibitory net function so as to enhance outputs as compared with inputs, and the further enhancements when the cortical net is added, are explored both mathematically and by simulation. This is extended to learning on cortical afferent and lateral connections. A global wave structure, arising on the inhibitory net in a similar manner to that of pattern formation in a negative laplacian net, is seen to be important to all of these activities. Simulations are only performed in one dimension, although the global nature of the activity is expected to extend to higher dimensions. Possible implications are briefly discussed.

Argon laser therapy for hemorrhagic radiation proctitis: long-term results.

In chronic radiation proctitis bleeding occurs from mucosal friability and neovascular telangiectasias. Fourteen patients with bleeding from chronic radiation proctitis underwent endoscopic argon laser therapy at 4 to 8 W. The goal of treatment was obliteration of all telangiectasias. The average follow-up was 35 months. Of the 51 procedures, 48 (94%) were performed on outpatients with enema preparation and little or no sedation. A median of three procedures was performed per patient, with two sessions required for initial control of bleeding. Ten patients (71%) required maintenance therapy for recurrent bleeding from telangiectasias that developed after initial therapy. The mean interval between maintenance sessions was 7 months. No immediate or late complications occurred.

The amino acid sequence of Neurospora NADP-specific glutamate dehydrogenase. The tryptic peptides.

The NADP-specific glutamate dehydrogenase of Neurospora crassa was digested with trypsin, and peptides accounting for 441 out of the 452 residues of the polypeptide chain were isolated and substantially sequenced. Additional experimental detail has been deposited as Supplementary Publication SUP 50052 (11 pages) with the British Library (Lending Division), Boston Spa, Wetherby, W. Yorkshire LS23 7BQ, U.K., from whom copies may be obtained under the terms given in Biochem J. (1975) 145, 5.