Flow cytometry analysis of peripheral blood lymphocytes in patients with choroidal melanoma.

PURPOSE: To evaluate peripheral blood lymphocyte subpopulations in patients with choroidal melanoma. METHODS: In this prospective study, peripheral blood lymphocytes of 226 patients afflicted with choroidal melanoma were analyzed by flow cytometry and compared with those of 49 age-matched and gender-matched control subjects. Subpopulations of peripheral blood lymphocytes were further identified by monoclonal antibodies specific to cell-surface markers. Statistical analysis was performed by a Student t test. RESULTS: There was no overall difference between the patients with choroidal melanoma and the control subjects with regard to peripheral blood lymphocyte subpopulations. However, when the patients were divided into subgroups based on their clinical characteristics, differences in natural killer (NK) cell population and activated T cells were noted in two subgroups. Patients with ciliary body involvement showed a statistically significant reduction in NK cells (194 +/- 101 vs 260 +/- 178 per mm3; P = .01). The number of activated T cells in this subgroup of patients was increased but not statistically significantly (7.32 +/- 4.79 vs 6.09 +/- 4.34 per mm3; P = .08). In patients with extrascleral extension, a statistically significant increase in activated T cells was noted (9.84 +/- 7.41 vs 6.25 +/- 4.3 per mm3; P = .02). The NK cells in this subgroup of patients were also reduced, but the reduction did not achieve statistical significance (178 +/- 123 vs 248 +/- 167 per mm3; P = .24). CONCLUSIONS: We noted statistically significant differences in peripheral blood lymphocytes in two subgroups of patients with clinically less favorable choroidal melanoma.

Ouabain plasma level kinetics and removal by dialysis in chronic renal failure. A study in fourteen patients.

Ouabain plasma level kinetics and removal by dialysis were studied in 14 dialysis-dependent patients with chronic renal failure. Each received one 400 mug intravenous dose of unlabeled ouabain (9 patients also received 83 muCi of 3-H-ouabain) at the onset of a routine 4-hour hemodialysis. Plasma concentration fell rapidly the first few hours, and after 5 to 10 hours declined exponentially with a mean half-life of 50 plus or minus 19 (SD) hours. Ouabain recovery in dialysis bath was 11.5% plus or minus 2.2% the first 2 hours and only 3.4% plus or minus 0.5% the next 2 hours after an intravenous dose, due to rapid removal of ouabain from the extracellular fluid compartment by tissue uptake. Hence, hemodialysis is relatively ineffective for reducing ouabain body stores. Ouabain elimination in patients with chronic renal failure is significantly slower than in normal subjects (P smaller than 0.01), but significantly more rapid than that reported for digoxin (P smaller than 0.01) and digitoxin (P smaller than 0.01) in patients with chronic renal failure, a potentially useful characteristic in treating acute cardiac problems among such patients.

Rhegmatogenous retinal detachment in eyes with uveal melanoma.

PURPOSE: To describe the clinical features, surgical management, and outcome of patients with uveal melanoma who presented with or later developed a rhegmatogenous retinal detachment. METHODS: We retrospectively identified four patients who presented with uveal melanoma and rhegmatogenous retinal detachment simultaneously and six patients in whom a rhegmatogenous retinal detachment developed 11-100 months (mean, 44.8 months) after radiotherapy for a choroidal melanoma. RESULTS: All four patients with simultaneous presentation of uveal melanoma and retinal detachment underwent successful retinal detachment repair (cases 1 and 4, scleral buckle; case 2, pars plana vitrectomy, and case 3, pneumatic retinoplexy). Rhegmatogenous retinal detachment occurring after proton beam or plaque radiotherapy of uveal melanoma was repaired successfully in five of six patients with scleral buckling alone or in combination with pars plana vitrectomy. In the short follow-up period of this study, we did not observe tumor recurrence either before or after retinal detachment repair. CONCLUSION: Rhegmatogenous retinal detachment associated with uveal melanoma may be treated successfully using conventional retinal surgical techniques. The benefits of retinal detachment repair must be weighed against any theoretical increased risk of extra-scleral extension of the melanoma. Long-term follow-up evaluation will be required to determine the safety of various retinal detachment repair techniques in these eyes.