Long-Term Subdural Strip Electrocorticographic Monitoring of Ictal Déjà Vu

Summary: We report a series of 8 patients with ictal déjà vu. Subdural strip electrocorticographic (ECoG) monitoring localized the ictal epileptogenic focus as follows: right (n = 6) and left (n = 2) mesiotemporal lobe. In all 8 patients, the left hemisphere was dominant for language function based on intracarotid amytal testing. In 6 right-handed patients, ictal déjà vu was associated with a right temporal lobe focus. However, in the 2 left-handed patients, the ictal focus was left temporal lobe. Although ictal déjà vu localizes the epileptic focus to temporal lobe, this experiential phenomenon appears to lateralize to the hemisphere nondominant for handedness.     

Influence of Malaria Infection on the Elaboration of Soluble Mediators by Adherent Mononuclear Cells

MALARIA RESULTS IN TWO SEEMINGLY PARADOXICAL PERTURBATIONS OF THE IMMUNE RESPONSE: polyclonal B-cell activation and immunosuppression. To determine what immunoregulatory role mediators secreted by adherent cells might play in these alterations, we cultured adherent cells from uninfected mice and from mice at different times during infection with Plasmodium berghei or P. yoelii. Culture supernatants obtained from these cells were tested for their ability to enhance the in vitro proliferative responses of thymocytes to suboptimal concentrations of concanavalin A or to inhibit the mitogen-stimulated proliferation of normal spleen cells. Supernatants obtained from adherent cells of mice early in infection (days 1 to 3) contained significantly elevated levels of enhancing activity which on Bio-Gel P-100 chromatography resembled lymphocyte-activating factor. Later in infection (days 4 and 5), these supernatants contained inhibitory activity. Normal adherent cells, when cocultivated in vitro with parasitized erythrocytes, ingested parasite debris and were stimulated to produce the enhancing factor. At high parasite/adherent-cell ratios, cells elaborated an inhibitory factor. These findings suggest that during malaria, adherent cells are converted from a nonspecific helper role to a nonspecific suppressor role. This modulation in function may be due to the direct interaction between adherent cells and parasitized erythrocytes.     

In vitro parasite-monocyte interactions in human leishmaniasis: possible role of fibronectin in parasite attachment.

Leishmania spp. must attach to mononuclear phagocyte surfaces before entering this host cell. We investigated the potential role of fibronectin in facilitating parasite attachment. Human plasma fibronectin bound to axenically cultured promastigotes, and promastigotes and amastigotes preferentially bound to fibronectin-coated cover slips. Promastigotes grown in the absence of fibronectin were strikingly deficient in their ability to attach to human monocytes compared with promastigotes grown in the presence of fibronectin. Rabbit anti-human plasma fibronectin antiserum decreased promastigote and amastigote attachment to monocytes. Immunoglobulin G F(ab')2 and Fab fragments also reduced the ability of amastigotes to bind to monocytes. Antiserum pretreatment of amastigotes followed by washing resulted in reduced parasite binding, whereas antibody pretreatment of monocytes did not. Addition of exogenous fibronectin did not enhance parasite attachment to monocytes. These findings suggest that Leishmania spp. can bind fibronectin and may utilize this glycoprotein to facilitate attachment to the mononuclear phagocytes that they infect.     

In vitro parasite-monocyte interactions in human leishmaniasis: effect of enzyme treatments on attachment

Essential to the pathogenesis of leishmaniasis is the ability of Leishmania spp. to attach to mononuclear phagocyte surfaces before entering this host cell which they parasitize. We have investigated the attachment phase of infection in vitro by quantitating the percent of human peripheral blood monocytes pretreated with cytochalasin (to prevent parasite entry) to which tissue-derived L. tropica amastigotes will attach during coincubation at 37 degrees C in serum-free medium. We determined that pretreatment of parasites with trypsin, chymotrypsin, Pronase, and neuraminidase reduced attachment. In contrast, parasites treated with beta-galactosidase had an enhanced ability to attach to host cells. Treatment of monocytes with chymotrypsin and Pronase, but not with trypsin or neuraminidase, reduced attachment of untreated amastigotes. We propose that in vitro amastigote attachment under serum-free conditions depends on the interaction of protein determinants on the surface of both parasite and host cell.     

Autonomic responses to suggestions for cold and warmth in hypnosis

The goal of the present study was to investigate whether suggestions for cold or warmth during hypnosis affect fingertip skin temperature. Hypnosis without specific suggestions for cold or warmth ('neutral hypnosis') caused a drop in respiration frequency, however, pulse rate, fingertip skin temperature, and electrodermal activity were not affected. The cold and warmth suggestions decreased and increased fingertip skin temperature, respectively. Compared with the neutral trance phase, the other three autonomic variables measured were also affected by suggestions for cold. However, there was no association between the changes in autonomic variables induced by suggestions and hypnotizability scores measured by the 'Stanford Hypnotic Clinical Scale for Adults'. Fingertip skin temperature was mostly affected when the images used for the cold and warmth suggestions during hypnosis included experiences of physical temperature and psychological stress or relaxation, indicating that the psychological content of the imagery amplified the autonomic response.     

EEG operant conditioning in a monkey model: II. EEG spectral analysis.

EEG power spectral analysis was studied from 14 (alumina-gel) chronically epileptic, undrugged monkeys during an EEG operant conditioning experiment. The composite profile of the average epileptic monkey shows the majority of power to be below 10 Hz. Because of the large variance in the data, no significant changes in the EEG power spectra could be detected as a function of conditioning. The possible reasons for this large variance are discussed. Hypothesis from previous human "biofeedback" studies would allow the prediction that those frequencies corresponding to the mu and sensory-motor-rhythm should negatively covary with seizure frequency. Data from this study did not support such assertions. The method of using spectral analysis for quantifying changes in the EEG which covary with operant conditioning is evaluated.     

Safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing oral anticoagulation

OBJECTIVES: Ongoing oral anticoagulation (OA) contraindicates transurethral electroresection of the prostate. We evaluated the safety and effectiveness of photoselective vaporization of the prostate (PVP) in patients on ongoing OA with coumarin derivatives, aspirin, or clopidogrel, complaining of symptomatic benign prostatic hyperplasia (BPH). METHODS: We evaluated perioperative parameters, functional outcome, and adverse events up to 24 mo postoperatively of patients on OA, and compared results with 92 men at normal risk without anticoagulant therapy undergoing PVP for the same indication (control). RESULTS: Within 40 mo, 116 men on OA were included, with 31% (n=36) receiving coumarin derivatives; 61% (n=71), aspirin; and 8% (n=9), clopidogrel. Mean prostate volume (62+/-34ml vs. 57+/-25ml; p=0.289) and mean operation time (67+/-28min vs 63+/-29min; p=0.313) were comparable with control. We observed no bleeding complications necessitating blood transfusions. Average postoperative decrease of haemoglobin was 8.6% for patients on OA versus 8.8% for control. At 3, 6, 12, and 24 mo postoperatively, improvement of the International Prostate Symptom Score ranged from 60-70%; postvoid residual volume, 80-88%; and average maximum urinary flow rate, 116-140%, respectively. Postoperative complications were low and comparable with control. CONCLUSIONS: PVP is characterized by excellent haemostatic properties and very low intraoperative complication rate even in patients on OA. On the basis of our perioperative results, we recommend PVP as first-line procedure for patients with symptomatic BPH at high risk of bleeding.     

Retroperitoneoskopische Nierenchirurgie

Retroperitoneoscopy enables quick, simple, and direct access to the retroperitoneal cavity. We describe our operative technique and discuss the advantages and disadvantages of retroperitoneoscopy. We report on our experience with this operative technique after 360 procedures: nephrectomy, partial nephrectomy, living donor nephrectomy, cryotherapy of renal tumors, pyeloplasty, adrenalectomy, and further operations. In addition, we discuss indications that are suitable for beginners to retroperitoneoscopy and some topics that require special attention.