Radiofrequency ablation and surgical resection of liver metastases from uveal melanoma.

BACKGROUND: The resection of liver metastasis from uveal melanoma (LMUM) remains controversial. In this study, we evaluated treatment with radiofrequency ablation (RFA) for liver metastases alone or in combination with surgical liver resection. METHODS: A total of 72 patients with LMUM were evaluated in this study. Of these, 57 patients underwent surgical resection (S) while 15 patients had RFA ± S. Clinicopathologic factors were evaluated in terms of recurrence and survival using Chi-square and log-rank tests, respectively. RESULTS: We studied 22 metastases treated by RFA. There were no statistically significant differences between the groups in terms of median age of onset, synchronous nature of the metastases, time from primary tumour treatment to liver metastasis, diameter of the largest metastasis, presence of liver miliary disease, and the type of liver resection. There was a statistically lower number of liver metastases and more bilobar metastases in the RFA group than in the S group. The median overall survival after liver surgery was 27 months in group S and 28 months in the RFA group ± S. The median disease-free survival was 10 months in group S and 7 months in the RFA group ± S. There were no statistically significant differences in the median overall survival and disease-free survival between groups. CONCLUSIONS: The results of this retrospective analysis show that RFA can be used to treat liver metastases to spare the hepatic parenchyma. RFA ± liver surgery and liver surgery alone demonstrate similar survival times.

Preserved memory capacities in aged Lou/C/Jall rats.

Although memory impairments are a hallmark of aging, the degree of deficit varies across animal models, and is likely to reflect different states of deterioration in metabolic and endocrinological properties. This study investigated memory-related processes in young (3-4 months) and old (24 months) Sprague-Dawley rats (SD), which develop age-linked pathologies such as obesity or insulin-resistance and Lou/C/Jall rats, which do not develop such impairments. In short- and long-term memory recognition tasks, old Lou/C/Jall rats were never impaired whereas old SD rats were deficient at 1 and 24h latencies. The expression of N-methyl-d-aspartate receptors (NMDAR)-mediated synaptic plasticity in CA1 hippocampal networks shifted towards lower activity values in old Lou/C/Jall rats whereas long-term potentiation was impaired in age-matched SD rats. Age-related decrease in NR2A subunits occurred in both strains, extended to NR2B, NR1 and GluR1 subunits in older animals (28 months) but only in SD rats. Therefore, the Lou/C/Jall rats can be considered as a model of healthy aging, not only in terms of its preserved metabolism, but also in terms of cognition and synaptic plasticity.

The magnitude of hippocampal long term depression depends on the synaptic location of activated NR2-containing N-methyl-D-aspartate receptors.

Activation of N-methyl-D-aspartate receptors (NMDARs) is the first step in the induction of certain forms of synaptic plasticity in the hippocampus. In the adult rat hippocampus, NMDARs are composed almost exclusively of NR1 and NR2 subunits with NR1 subunits being mainly associated with either NR2A and/or NR2B subunits. The role played by the different subunits in synaptic plasticity is still controversial. In the present study, we used two different long term depression (LTD) -inducing protocols (electrical and chemical stimulation) to show that activation of NR2A-containing NMDAR subunits leads to the induction of LTD. We also demonstrated that extrasynaptic NR2B-containing NMDARs regulate the magnitude of LTD by exerting a control over the function of synaptic NR2A-containing NMDARs while having no effect on plasticity in the absence of synaptic receptor activation. Taken as a whole, these experiments demonstrate that NMDAR subunits play different roles according to their nature (NR2A or NR2B) and location (synaptic versus extrasynaptic). This sheds new light on the functional role of extrasynaptic NR2B containing-NMDARs. These results are particularly important for a better understanding of certain pathological disorders associated with glutamatergic overactivity.

[Pregnant and mentally incompetent]. / Gravida en wilsonbekwaam.

Two women, aged 31 and 36 years, under treatment for schizophrenia and psychotic episodes, respectively, became pregnant and decided to discontinue their medication. Thereupon the psychiatric disorder recurred and they refused--i.e. they were unable--to consent to a proposed treatment or investigation regarding their pregnancies. The necessary consent had to be obtained from a legal guardian. This was the husband in the first, urgent case. In the second case approval from the judge was obtained for the patient to be admitted against her will to protect her life and that of the foetus. In the Netherlands obstetric intervention to protect the life of the mother or her unborn child is legally regulated by the Wet Bijzondere Opnemingen in Psychiatrische Ziekenhuizen (Act on Compulsory Admissions to Psychiatric Hospitals) and the Wet op de Geneeskundige Behandelingsovereenkomst (Act on Agreement Concerning Medical Treatment).

Longitudinal evaluation of uteroplacental and umbilical blood flow changes in normal early pregnancy.

The hemodynamic changes in the uteroplacental circulation and the umbilical artery were evaluated in normal pregnancy from 8 to 14 weeks' gestation. A 6-9-MHz broad-band transvaginal sonographic transducer combined with pulsed color Doppler was used to scan 37 healthy volunteer pregnant women at weekly intervals. Vascular impedance to blood flow in all examined vessels decreased significantly throughout the first gestational trimester. Resistance to flow was highest in the main uterine artery and decreased towards the spiral artery. When the flow velocity waveform patterns of the arteries under investigation were analyzed, specific changes were observed. The diastolic notch was present in the spiral artery flow velocity waveform in all cases until 10 weeks' gestation. From then, the diastolic notch disappeared progressively and was absent in 100% of cases at 13 weeks. The diastolic notch in the arcuate artery disappeared within 2 weeks of its disappearance in the spiral artery. We could not detect intervillous blood flow during the first 12 weeks. From then on, intervillous flow was observed in most pregnancies, reaching 100% at 14 weeks' gestation. These changes reflect the growth and development of the uteroplacental circulation. The absence of detectable intervillous flow during most of the first trimester confirms the concept that, during the first 3 months of gestation, blood flow to the intervillous space is inhibited by trophoblastic plugs.