Twenty-nine patients who were referred with the possible diagnosis of constrictive pericarditis underwent electrocardiographically gated transverse spin-echo magnetic resonance (MR) imaging to determine the accuracy of spin-echo MR imaging for the diagnosis of constrictive pericarditis and to compare the morphologic features of constrictive pericarditis with those of restrictive cardiomyopathy as seen on spin-echo MR images. Constrictive pericarditis was verified by means of surgery and/or catheterization in 17 patients. The sensitivity, specificity, and accuracy of MR imaging in the diagnosis of constrictive pericarditis were 88%, 100%, and 93%, respectively. Thickened pericardium was observed in 88% of patients with proved constrictive pericarditis. Pericardial thickening was not identified in patients with restrictive myocarditis (n = 4). The most frequent site of pericardial thickening was over the right ventricle. In constrictive pericarditis, the signal intensity of the thickened pericardium was similar or decreased compared with that of the myocardium. Indirect findings of impaired right ventricular diastolic filling (eg, dilatation of the inferior vena cava and right atrium) were identified in constrictive pericarditis and restrictive cardiomyopathy. MR imaging can serve as a noninvasive examination for the definitive diagnosis of constrictive pericarditis and can help distinguish between constrictive pericarditis and restrictive cardiomyopathy on the basis of pericardial thickness.

The histories of 121 Stage II melanoma patients were reviewed to determine the value of monitoring serum LDH in postoperative follow‐up examinations. Charts of 58 Stage III patients who had autopsies at UCLA also were reviewed to define the relationship between an elevated LDH and liver metastases. The sensitivity and specificity of LDH as an indicator of disease recurrence were 72.1% and 97.0%, respectively. As an indicator of liver metastases, LDH had a sensitivity and specificity of 95.1% and 82.8% in the Stage II patient group and 86.5% and 57.1% in the Stage III autopsied group. An elevated LDH was the first indication of recurrent disease in 11/88 (12.5%) Stage II patients and was almost as frequent an indicator of recurrent disease as pulmonary metastases found on chest x‐ray. Mean survival following elevation of LDH was 5.9 months whether or not liver metastases were present. Monitoring of serum LDH can provide useful information in the postoperative follow‐up of patients with melanoma.

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Eighty-two Stage II melanoma patients with inguinal lymph node metastases have undergone ilioinguinal node dissections at UCLA during the past 10 years. Twenty-four (29.3%) patients had involvement of both inguinal and iliac nodes, whereas 58 (70.7%) patients had only inguinal metastases. The frequency of iliac metastases did not relate to location, Clark's level or thickness of the primary tumor or interval from diagnosis of primary tumor to lymphadenectomy, but was related to the number of inguinal nodes involved with metastases, rising from 14.6% with one positive inguinal node to 50% with four or more inguinal node metastases. Twenty of 24 (83.3%) patients with inguinal and iliac node metastases developed recurrent disease, whereas 32/58 (55.2%) patients with only inguinal node metastases and no tumor in the iliac nodes recurred. The time to recurrence was much shorter if iliac nodes were diseased (median disease-free interval 5.8 months versus 25.6 months). Three of five patients with clinically negative but histologically positive inguinal and iliac nodes survived 5 years, while only 1/18 patients with clinically positive inguinal nodes and diseased iliac nodes lived 5 years. Those with clinically negative but histologically positive inguinal nodes and iliac metastases had recurrence and survival rates similar to those with clinically negative but histologically positive inguinal nodes and no iliac metastases. Ilioinguinal lymphadenectomy provides significant prognostic information for Stage II patients with inguinal metastases and may be therapeutic for those with iliac metastases. Therefore, ilioinguinal dissection is the operation of choice for melanoma patients with regional metastases to the inguinal area.