Source localization of EEG activity during hypnotically induced anxiety and relaxation.

The engagement of different brain regions which implement subjectively experienced emotional states in normals is not completely clarified. Emotional states can conveniently be induced by hypnosis-based suggestions. We studied brain electric activity during hypnotically induced anxiety and relaxation in 11 right-handed normals (5 males, 6 females, mean age 26.5+/-7.6 years). After induction of light hypnosis, anxiety and then relaxation was suggested using a standardized text (reverse sequence in half of the subjects). Nineteen-channel, eyes-closed EEG (20 artifact-free s/subject) was analyzed (source localization using FFT approximation and low resolution electromagnetic tomography, LORETA). Global tests revealed the strongest difference (P<0.005) between EEG source gravity center locations during the two emotional states in the excitatory beta-2 EEG frequency band (18.5-21 Hz). Post hoc tests showed that the sources were located more right during anxiety than during relaxation (P=0.01). LORETA specified that anxiety showed maximally stronger activity than relaxation in right Brodmann area 10, and relaxation showed maximally stronger activity than anxiety in left Brodmann area 22. Clearly, the two induced emotional states were associated with activity of different neural populations. Our results agree with reports on brain activity shifted to the right (especially fronto-temporal) during negative compared with positive emotions, and support the role of beta-2 EEG frequency in emotional states.

A successful treatment for hepatocellular carcinoma with atrial tumor thrombus.

A 66-year-old man with an advanced hepatocellular carcinoma and tumor thrombus extending into the right atrium was treated by transcatheter arterial infusion of lipiodol and aclarubicin. This brought about a remarkable reduction of the tumor and the disappearance of the right atrial tumor thrombus. The tumor was then radically resected by hepatic posterior segmentectomy with combined resection of the right hepatic vein, where the tumor thrombus remained. He is doing well without any signs of recurrence 22 months after the operation.

Augmented enhancement of in vitro production of inflammatory cytokines in peripheral blood mononuclear cells in patients undergoing simultaneous resection of the liver and gastrointestinal tract.

OBJECTIVE: To determine changes in the production of inflammatory cytokines and acute-phase proteins, and in the priming of peripheral blood mononuclear cells (PBMC), as mechanisms for the high incidence of postoperative complications in patients who have undergone hepatectomy simultaneously with resection of the gastrointestinal tract. DESIGN: Prospective, clinical study for 3 wks after operation. SETTING: A surgical department in a university hospital. PATIENTS: Twenty-one consecutive adult patients with synchronous and metachronous hepatic metastases from gastrointestinal malignancies, curatively resected by simultaneous resection (group A, n = 9) or by hepatectomy alone (group B, n = 12), and 15 patients with gastrointestinal malignancies undergoing curative resection (group C). INTERVENTION: Peripheral venous blood samples collected before operation and on days 1, 3, 5, 7, 10, 14, and 21 after operation. MEASUREMENTS AND MAIN RESULTS: The serum and plasma levels of acute-phase proteins, interleukin (IL)-1beta, IL-6, tumor necrosis factor (TNF)-alpha, and endotoxin were measured. The in vitro production of IL-1beta and TNF-alpha by PBMC was also determined by the stimulation of lipopolysaccharide. The incidence of postoperative complications was significantly higher in group A than in groups B and C. The serum levels of IL-6 increased significantly, with a peak at postoperative day 1 in all groups, and the peak levels of IL-6 in groups A and B were significantly higher than that in group C. The serum levels of all acute-phase proteins measured in this study (alpha1-antitrypsin, haptoglobin, and C-reactive protein) increased markedly after operation in group C (p < .05). In group A, only C-reactive protein increased after operation, but its peak level was lower than in groups B and C (p < .05). Although IL-1beta and TNF-alpha in the serum were not detectable in any of the groups during the entire study period, the lipopolysaccharide-induced in vitro production of IL-1beta and TNF-alpha by PBMC in all groups was significantly elevated after operation, with a peak at days 1 and 3 after operation, respectively. In addition, the elevation of the in vitro production of IL-1beta and TNF-alpha in group A was significantly greater than that in group C, lasting until postoperative day 5 (IL-1beta) and postoperative day 10 (TNF-alpha). The levels of plasma endotoxin increased significantly in all groups, with a peak at day 1 after operation, and the peak levels were significantly higher in group A than in groups B and C. There was a significant correlation between the peak levels of in vitro TNF-alpha production and the peak levels of plasma endotoxin (r2 = .331, p< .01). CONCLUSIONS: The augmented enhancement of the priming of PBMC as a result of surgery in patients undergoing simultaneous resection of the liver and gastrointestinal tract, together with the reduced synthesis of the acute-phase reactants and impaired host defense mechanisms, might be responsible for the high incidence of postoperative complications, possibly because subsequent exposure of primed macrophages/monocytes to triggering substances such as endotoxin and bacterial components after operation results in inappropriate production of inflammatory cytokines.

Immunization of the elderly and patients with collagen vascular diseases with live varicella vaccine and use of varicella skin antigen.

Elderly subjects and patients with collagen vascular diseases were immunized with a live varicella vaccine to assess the vaccine's potential for preventing herpes zoster. An improved varicella-zoster virus (VZV) skin test antigen was then used to assess cell-mediated immunity to VZV. The antigen was prepared from culture fluid of VZV-infected cells and had far less protein content than crude antigen prepared by sonication of infected cells. In 11 of 12 patients with ophthalmic zoster and 17 of 21 with dermal zoster, the skin reaction was negative at the beginning of the disease but became positive later. After two doses of VZV vaccine, 8 of 12 elderly subjects (greater than 60 years old) and 4 of 6 patients with collagen vascular diseases, who were VZV-skin test negative but purified protein derivative tuberculin test-positive, became VZV skin test-positive.

Effects of perioperative protease inhibitor on inflammatory cytokines and acute-phase proteins in patients with hepatic resection.

AIM: The objective of this study was to examine the effects of perioperative administration of ulinastatin, or urinary trypsin inhibitor (UTI), on inflammatory cytokines and acute-phase proteins induced by inflammatory cytokines in patients who had undergone hepatic resection. METHOD: Twenty patients admitted to the hospital for hepatic resection were equally randomized to one of two groups: the UTI group, those who were administered perioperative UTI, and the control group. RESULTS: The UTI group had no adverse effects from using UTI. Production of serum interleukin-6 (IL-6) tended to be attenuated in the UTI group when compared with the control group. Moreover, the UTI group had significantly decreased positive acute-phase C-reactive protein (p < 0.05) and significantly increased negative acute-phase protein prealbumin and retinol-binding protein (p < 0.05). Serum IL-6 levels significantly correlated with serum C-reactive protein levels on postoperative day 1 (r = 0.70, p < 0.01). CONCLUSION: These results suggest that perioperative administration of UTI might deserve further assessment for use in modulating acute-phase responses without adverse effects in patients who have undergone hepatic resection.

EEG source localization and global dimensional complexity in high- and low- hypnotizable subjects: a pilot study.

Individuals differ in hypnotizability. Information on hypnotizability-related EEG characteristics is controversial and incomplete, particularly on intracerebral source localization and EEG dimensionality. 19-channel, eyes-closed resting EEGs from right-handed, healthy, 8 high- and 4 low-hynotizable subjects (age: 26.7 +/- 7.3 years) were analyzed. Hypnotizability was rated after the subjects' ability to attain a deep hypnotic stage (amnesia). FFT Dipole Approximation analysis in seven EEG frequency bands showed significant differences (p < 0.04) of source gravity center locations for theta (6.5-8 Hz, more posterior and more left for highs), beta-1 and beta-2 frequencies (12.5-18 and 18.5-21 Hz; both more posterior and more right for highs). Low Resolution Electromagnetic Tomography (LORETA) specified the cortical anteriorization of beta-1 and beta-2 in low hypnotizables. Power spectral analysis of Global Field Power time series (curves) showed no overall power differences in any band. Full-band Global Dimensional Complexity was higher in high-hypnotizable subjects (p < 0.02). Thus, before hypnosis, high and low hypnotizables were in different brain electric states, with more posterior brain activity gravity centers (excitatory right, routine or relaxation left) and higher dimensional complexity (higher arousal) in high than low hypnotizables.

Hepatic resection of liver metastases from gastric carcinoma.

OBJECTIVES: Previous reports have indicated that results of the surgical resection of hepatic metastases from gastric carcinoma have been unsatisfactory. We therefore evaluated the results of aggressive surgical resection for hepatic metastases from gastric carcinoma, to identify candidates with a better likelihood of survival. METHODS AND RESULTS: Twenty-one patients with synchronous or metachronous hepatic metastases from gastric carcinoma underwent hepatic resections. Five patients were still alive, without recurrence, at 10, 41, 46, 117, and 176 months after their hepatic resection. Sixteen patients died of recurrence 5-33 months (mean, 10 months) after hepatic resection. A significant difference in the number of node metastases (solitary or multiple) and in the tumor-free margin of the resection (< 10 mm or > 10 mm) was found between survivors and those who died. CONCLUSION: Hepatic resection for hepatic metastases from gastric carcinoma may improve the prognosis in patients with a solitary metastasis if adequate tumor-free margins (> 10 mm) can be obtained.

Reduced hepatic functional reserve in cirrhosis and obstructive jaundice with special reference to histological morphometric analysis and galactose elimination capacity.

To evaluate liver dysfunction in patients with obstructive jaundice (OJ), morphological and functional hepatic mass was analyzed in comparison with cirrhosis (LC). Total hepatic parenchymal ratio (THPR) was estimated by morphometric analysis and hepatic functional mass by galactose tolerance test (GaTT) in 30 patients who underwent hepatectomy. The value of GaTT in patients with LC was remarkably depressed compared to those with normal liver function (p < 0.001). It was also depressed in OJ (p < 0.05 vs. normal liver), but less than in LC (p < 0.05). However, THPR decreased only in LC (p < 0.05 vs. either normal liver or OJ). A significant correlation between the value of GaTT and THPR was revealed in patients with LC, but not in OJ. These results suggested that liver dysfunction in OJ was independent of the decreased number of hepatocytes, differing from LC.