Active immunotherapy by reinduction with a polyvalent allogeneic cell vaccine correlates with improved survival in recurrent metastatic melanoma

Background We have observed prolonged survival in patients undergoing vaccine reinduction after resection of recurrent metastatic melanoma and adjuvant polyvalent allogenic cell vaccine (PACV) immunotherapy. We hypothesized that reinduction with a more intensive vaccine regimen would re-stimulate specific immune responses that were correlated with survival after recurrence. Methods From 1996 to 1998, 194 patients developed recurrence during adjuvant PACV (CancerVax vaccine) treatment after resection of metastatic melanoma. Recurrent disease was treated with or without vaccine reinduction. Reinduction regimen entailed an increased vaccine frequency and coadministration of two doses of bacille Calmette-Guérin (BCG). PACV Delayedtype hypersensitivity (DTH) responses were prospectively recorded. Survival was defined as the interval from recurrence to death. Results Ninety-four patients underwent reinduction immunotherapy. DTH responses to PACV before recurrence increased significantly after reinduction therapy (P=.0001). The median survival time was 37 months for reinduced patients and 17 months for other patients. On multivariate analysis, reinduction status remained a significant prognostic variable (P=.0277). In the reinduction group, there was a significant correlation between PACV DTH responses and survival (P=.0178). Conclusions Reinduction vaccine regimen can enhance immune responses in previously immunized patients and is associated with prolonged survival after recurrence in patients receiving the same active specific immunotherapy. Presented at the Society of Surgical Oncology annual meeting. Washington, DC, March 15–18, 2001.     

Bioactive asterosaponins from the starfish Culcita novaeguineae

Two new sulfated steroidal pentaglycosides（asterosaponins）,novaeguinosides Ⅰ（2） and （Ⅱ）2,along with the known regularoside B（1）were isolated from the starfish Culcita novaeguineae.Their structures were elucidated by extensive NMR techniques as well as chemical evidence.     

Biliary‐enteric bypass in unresectable malignant hilar biliary obstruction: Kwong Wah Hospital experience

Objective : To evaluate the efficacy of biliary‐enteric bypass in the palliation of malignant hilar biliary obstruction. Materials and Methods : Records of 19 patients from 1995 to 1998 were reviewed. There were 13 patients with cholangiocarcinoma and 6 patients with carcinoma of the gallbladder. Single biliary‐enteric bypass had been performed in 13 of the patients; the rest had more than one biliary‐enteric anastomosis. Results : The 30‐day mortality was 21% (4/19 patients). Bile leakage occurred in 2 patients, leading, in both, to fatality. Excluding the 30‐day mortality, the median survival of patients with carcinoma of the gallbladder and cholangiocarcinoma was 116 days (43–200) and 202 days (47–1207), respectively. The mean hospital stay was 31 days (13–59) and all patients were discharged with their symptoms relieved and a drop in bilirubin of at least two‐thirds their pre‐operative level. The late complication rate was 26.7% (4/15 patients). Conclusion : Biliary‐enteric bypass is effective in the palliation of symptoms of patients suffering from unresectable hilar biliary obstruction, although it carries considerable mortality and morbidity. Stenting, rather than surgery, should be considered for patients with unresectable gallbladder cancer.      

Cervical carcinoma: MR imaging with integrated endorectal/phased-array coils: a pilot study

The purpose of this study was to investigate the value of using MRI with integrated endorectal/phased-array coils for the staging and determination of the extent of cervical carcinoma. Twenty-two consecutive patients with biopsy-proven cervical carcinoma underwent MRI with integrated endorectal/phased-array coils before treatment. Magnetic resonance imaging was compared with clinical staging using surgical and pathological results as the gold standard. Eighteen of 22 patients underwent surgery. Seventeen of the 18 patients were correctly staged using an integrated endorectal/phased-array MRI with an overall staging accuracy of 94%. Fourteen of the 18 patients had a correct clinical staging with an overall staging accuracy of 78%. The overall accuracy of pelvic lymph node metastasis detection was 89% on MRI. These data showed that MRI using integrated endorectal/phased-array coils was more accurate than the clinical approach for the staging of cervical carcinoma. Magnetic resonance imaging using integrated endorectal/phased-array coils is a highly promising modality for detecting and staging cervical carcinomas.     

Thyrotoxicosis in a patient with secondary hypothyroidism.

We have described a patient with panhypopituitarism who developed thyrotoxicosis. There is a widespread belief that pituitary thyrotropin (TSH) is not a pathogenetic factor in most patients with thyrotoxicosis. Due to technical reasons, however, it has been difficult to entirely exclude the role(s) of TSH in the development of thyrotoxicosis. In this report hyperthyroidism appeared in a patient with TSH deficiency proved by the lack of response to TRH administration. This is the first known case in which TRH stimulation demonstrated total abscence of TSH before the onset of thyrotoxicosis. We cannot exclude the possibility that factors of adenohypophyseal origin play some role in the pathogenesis of thyrotoxicosis, but TSH per se does not play a role in the development of Graves' thyrotoxicosis.