A retrospective, nonrandomized, interventional case series of 8100 patients with uveal melanoma were evaluated for melanoma-related metastasis based on patient race. The patient race was Caucasian (n = 7918, 98%), Hispanic (n = 105, 1%), Asian (n = 44, o1%), or African American (n = 33, o1%). On the basis of race (Caucasian, Hispanic, Asian, and African American), significant differences were noted in mean age at presentation (58, 48, 44, and 52 years; Po0.001), distance of posterior tumor margin to foveola (5, 5, 6, and 4 mm; Po0.001), distance of posterior tumor margin to optic disc (5, 5, 6, and 4 mm) (Po0.001), tumor base (11, 12, 12, and 13 mm; Po0.001), tumor thickness (5.4, 7.1, 6.5, and 7.5 mm; Po0.001), intraocular hemorrhage (10, 14, 11, and 24%; P = 0.02), and rupture of Bruch's membrane (20, 27, 39, and 36%; P = 0.001). On the basis of multivariate analysis, the rate of metastasis increased with increasing age (Po0.001), ciliary body location (Po0.001), increasing tumor base (Po0.001), increasing tumor thickness (Po0.001), pigmented tumor (P = 0.001), subretinal fluid (P = 0.001), intraocular hemorrhage (P = 0.045), and extraocular extension (P = 0.036). KaplanMeier estimates of metastasis at 3, 5, and 10 were 8,15, and 25% in Caucasians;13,13, and 13% in Hispanics;4,4, and 36% in Asians;and 8,8, and 8% in African Americans. Compared with Caucasians, despite relative risk for metastasis of 0.31 for African Americans, 0.73 for Hispanics, and 1.42 for Asians, there was no statistical difference in metastasis, or death from uveal melanoma based on race. In summary, uveal melanoma showed similar prognosis for all races.
One hundred twenty-two consecutive patients (104 men; 18 women) were studied to determine the incidence and natural history of pericardial effusion occurring 2, 5, 10, and 20 to 50 days after cardiac surgery. Three patients had pericardial effusions before and 103 patients (91 men; three women) had effusions after surgery. Effusions were first recorded on the second postoperative day in 72 patients, on the fifth postoperative day in 29 patients, and on the tenth postoperative day in two patients. In 96 of these patients, effusions reached their maximum size by postoperative day 10. Of the 103 patients with effusions, 66 (64%) were followed to complete resolution. A specific pattern was observed in most resolving effusions. The echo-free space diagnostic of pericardial effusion became progressively more echo-dense as the effusion diminished in size. As the effusion became echo-dense, the posterior pericardium, which had been motionless, resumed its normal systolic anterior motion. One patient developed cardiac tamponade on postoperative day 3. We conclude that pericardial effusion occurs frequently after cardiac surgery, but that associated complications are rare. Circulation 69, No. 3, 506-511, 1984. ECHOCARDIOGRAPHY is the technique of choice for the diagnosis of pericardial effusion. In 1974. Horowitz et al.' correlated the size of pericardial effusions with the degree of separation between epicardium and pericardium. They were able to accurately detect as little as 15 to 20 ml of pericardial fluid. Martin et al.2 also showed that accurate quantification of pericardial effusion could be derived from M mode echocardiograms.2 The correlation for moderate-sized effusions was best, while that for small or large effusions was less accurate. Feigenbaum3 emphasized that lack of side effects and reproducibility of results make echocardiography ideally suited for serial studies. Also, with the development of portable equipment, the bedside evaluation of critically ill patients became possible.Pericardial effusion is very common after cardiac surgery. Despite the high incidence of effusion, the clinical approach to this problem remains controversial. Prospective studies defining the course and outcome of postoperative pericardial effusion have not
Escherichia coli heat-stable enterotoxin (STa) induces intestinal secretion by binding to enterocyte receptors and activating the guanylate cyclase-guanosine 3',5'-cyclic monophosphate (cGMP) system. The intermediate steps between binding of STa and secretion are poorly understood, due in part to the lack of a convenient system to study the effects of STa at the cellular level. To establish such a model, we investigated the binding of 125I-STa, STa activation of guanylate cyclase, and STa-induced increase in cGMP production in a well-characterized human colonic cell line, T84. Binding was specific, linear with cell number, and time, temperature and pH dependent, and reversible. ST may also be internalized by these cells. Addition of unlabeled STa competitively inhibited binding of 125I-STa. These parameters closely resemble those described in intact rat enterocytes and cell-free membrane preparations. STa stimulated guanylate cyclase and cGMP production in a dose-related manner. The similar dose-response relationships for binding, guanylate cyclase stimulation by STa, and cGMP production suggest that the guanylate cyclase-cGMP system is coupled to ST occupancy of specific receptors. These data, together with the fact that STa induces chloride secretion from T84 cells suggest that T84 cells are a suitable and convenient system to study the cellular mechanism of action of STa.
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