Hepatic Resection for Metastatic Melanoma: Distinct Patterns of Recurrence and Prognosis for Ocular Versus Cutaneous Disease

Background Resection of melanoma metastatic to the liver remains controversial. We evaluated the efficacy of hepatic resection in patients with metastatic ocular and cutaneous melanoma and assessed factors that could affect survival after resection. Methods Forty patients with hepatic melanoma metastasis underwent resection at four major hepatobiliary centers. Clinicopathologic factors were evaluated with regard to recurrence and survival by using χ² and log-rank tests. Results The primary tumor was ocular in 16 patients and cutaneous in 24. The median disease-free interval from the time of primary tumor treatment to hepatic metastasis was the same for both groups (ocular, 62.9 months; cutaneous, 63.1 months; P = .94). Most patients underwent either an extended hepatic resection (37.5%) or hemihepatectomy (22.5%). Twenty-six patients (65%) received perioperative systemic therapy. Thirty (75.0%) of 40 patients developed tumor recurrence. The median time to recurrence after hepatic resection was 8.3 months (ocular, 8.8 months; cutaneous, 4.7 months; P = .3). Patients with primary ocular melanoma were more likely to experience recurrence within the liver (53.3% vs. 17.4%; P = .015), whereas patients with a cutaneous primary tumor more often developed extrahepatic involvement. The 5-year survival rate for patients with a primary ocular melanoma was 20.5%, whereas there were no 5-year survivors for patients with cutaneous melanoma (P = .03). Conclusions Patterns of recurrence and prognosis after resection of hepatic melanoma metastasis differ depending on whether the primary melanoma is ocular or cutaneous. Resection should be performed as part of a multidisciplinary approach, because recurrence is common.     

MR urography in children. Part 1: how we do the F0 technique

MR urography (MRU) has been widely accepted as a substitute to intravenous urography for investigating children with a dilated urinary tract after preliminary assessment by US and voiding cystourethrography. Hydronephrosis is by far the main indication for MRU because upper tract dilatation is a frequent condition in infants and children. Recent advances in technology have allowed MR to go beyond morphology and to assess renal function parameters such as split renal function and drainage. In this article we report our routine practice of the F0 MRU technique. The main advantages of our protocol are no requirement for general anaesthesia, no bladder catheterization, use of low-dose gadolinium-based contrast agent (0.05–0.1 mmol/kg) and total acquisition time of 30 min or less.     

Adoption of patient-centered care practices by physicians: results from a national survey

BACKGROUND: Little is known about the extent to which primary care physicians (PCPs) practice patient-centered care, 1 of the Institute of Medicine's 6 dimensions of quality. This article describes the adoption of patient-centered practice attributes by PCPs. METHODS: Mail survey; nationally representative physician sample of 1837 physicians in practice at least 3 years postresidency. RESULTS: Eighty-three percent of PCPs surveyed are in favor of sharing of medical records with patients. Most physicians (87%) support team-based care. But, only 16% of PCPs communicate with their patients via e-mail; only 36% get feedback from their patients. Seventy-four percent of PCPs still experience problems with availability of patients' medical records or test results; less than 50% have adopted patient reminder systems. Thirty-three percent of physicians practicing in groups of 50 or more have adopted 6 to 11 of the 11 patient-centered care practices targeted in the survey compared with 14% of solo physicians. CONCLUSION: Although some patient-centered care practices have been adopted by most PCPs, other practices have not yet been adopted as broadly, especially those targeting coordination, team-based care, and support from appropriate information systems.     

Repeated subchronic exposure to phencyclidine elicits excessive atypical grooming in rats

Self-grooming in rodents is stereotypically sequenced and naturally occurs after arousal, novelty, or stress. Grooming expression and syntax resulting from stressful and appetitive conditions were assessed in male Long Evans rats treated daily with 10mg/kg of phencyclidine (PCP) for 15 days. Approximately 20 h after the 1st, the 8th, and/or the 15th injection, grooming was induced with water sprays, a loud sound, or smearing food. Behaviors expressed during the seconds or minutes that followed induction were videotaped and codified. Results showed that subchronic treatment with PCP amplified the grooming response in all stressful and appetitive conditions, but provoked a disorganization of grooming sequences only under the stressful, water condition. Thus, PCP enhanced grooming expression indiscriminately. However, this behavior had to serve both hygienic and stress managing purposes in order for chain sequencing to become disorganized as a consequence of drug treatment. These results suggest that the detailed examination of grooming expression and organization is an appropriate tool to measure stress-induced behavioral sensitization and motor functions in animal models of neuropsychiatric disorders such as schizophrenia.     

Meta-analysis of the effects of MI training on clinicians' behavior

MI-based interventions are widely used with a number of different clinical populations and their efficacy has been well established. However, the clinicians' training has not traditionally been the focus of empirical investigations. We conducted a meta-analytic review of clinicians' MI-training and MI-skills findings. Fifteen studies were included, involving 715 clinicians. Pre–post training effect sizes were calculated (13 studies) as well as group contrast effect sizes (7 studies). Pre–post training comparisons showed medium to large ES of MI training, which are maintained over a short period of time. When compared to a control group, our results also suggested higher MI proficiency in the professionals trained in MI than in nontrained ones (medium ES). However, this estimate of ES may be affected by a publication bias and therefore, should be considered with caution. Methodological limitations and potential sources of heterogeneity of the studies included in this meta-analysis are discussed.     

Phosphorus Amendment Reduces Hepatic and Renal Oxidative Stress in Mallards Ingesting Lead-Contaminated Sediments

Lead poisoning of waterfowl has been reported for decades in the Coeur d'Alene River Basin (CDARB) in Idaho as a result of the ingestion of lead-contaminated sediments. This study was conducted to determine whether the addition of phosphoric acid to CDARB sediments would reduce the bioavailability and toxicity of lead to the liver and kidney of mallards (Anas platyrhynchos). Mallards received diets containing 12% clean sediment (controls) or 12% sediment from three different CDARB sites containing 4520, 5390, or 6990 μ g/g lead (dry weight) with or without phosphoric acid amendment. Liver and kidney lead concentrations were significantly higher in all CDARB treatment groups and ranged from geometric mean values of 18.2 (liver) and 28.7 (kidney) for the first 2 sites to 22.5 (liver) and 45.6 (kidney) μ g/g (wet weight) for the third site. With amendments all liver lead concentrations were reduced 36 to 55%, and all kidney lead concentrations were lowered 54 to 73%. Unamended CDARB sediment from the third site resulted in the following hepatic effects: over 1.6-fold elevation of liver glutathione (reduced form; GSH) concentration, higher GSH S-transferase and oxidized glutathione (GSSG) reductase activities, and lower protein-bound thiols (PBSH) concentration. Renal effects included higher kidney GSH concentrations for all CDARB sites, with over 2.1-fold higher for the third site. Resulting kidney GSSG to GSH ratios were lower at two sites. At the third site, gamma-glutamyl transferase (GGT) activity was elevated, and lipid peroxidation as thiobarbituric acid-reactive substances (TBARS) was 1.7-fold greater. Amendment restored all hepatic variables as well as the renal variables TBARS and GGT so they did not differ from controls. Although amendments of phosphorus substantially reduced the bioavailability of lead and some of the adverse effects, lead concentrations in the tissues of mallards fed the amended sediments were still above those considered to be harmful to waterfowl under the present conditions.