Vaccine immunotherapy for a deadly disease like malignant melanoma: where do we stand?

The incidence of cancer and its related morbidity and mortality remain on the increase in both developing and developed countries. Cancer remains a huge burden on the health and social welfare sectors worldwide and its prevention and cure remain two golden goals that science strives to achieve. Among the treatment options for cancer that have emerged in the past one hundred years, cancer vaccine immunotherapy seems to present a promising and relatively safer approach as compared to chemotherapy and radiotherapy. The identification of different tumor antigens in the last fifteen years using a variety of techniques, together with the molecular cloning of cytotoxic T lymphocytes [CTLs]-and tumor infiltrating lymphocytes [TILs]-defined tumor antigens allowed more refining of the cancer vaccines that are currently used in different clinical trials. In a proportion of treated patients, some of these vaccines have resulted in partial or complete tumor regression, while they have increased the disease-free survival rate in others. These outcomes a re more evident now in patients suffering fro m melanoma. This review provides an update on melanoma vaccine immunotherapy. Different cancer antigens are reviewed with a detailed description of the melanoma antigens discovered so far. The review also summarizes clinical trials and individual clinical cases in which some of the old and current methods to vaccinate against or treat melanoma were used. These include vaccines made of autologous or allogenic melanoma tumor cells, melanoma peptides, recombinant bacterial or viral vectors, or dendritic cells

Is there a need for doppler vascular examination for the diagnosis of varicose vein? A prospective study

To compare the validity of a careful clinical examination with venous Doppler studies in the management of patients presenting with varicose veins. Subjects and Ninety-five consecutive patients presenting with varicose veins from September 1998 to August 1999 were included in this study. Of the 95 patients, 52 were males and 43 females. Eighty-four were expatriate laborers and 11 Kuwaiti nationals. Seventy-one were active workers under the age of 30. All of the patients underwent a full clinical examination for varicose veins, and a management plan was developed for each patient prior to Doppler venous study. The results of the Doppler studies were then compared with the clinical examination results, and the management plan was changed, if necessary, based on the Doppler results. Both clinical and Doppler examinations were equally effective in diagnosing primary varicose vein and identifying sites of venous incompetence. A family history for varicose veins was found in 21% and standing for a long period of time was a risk factor in 51% patients. The most common symptoms were pain and heaviness. Doppler study findings were useful in changing the management plan of 14 [15%] patients, 6 with recurrent varicose vein and 8 obese patients with chronic venous insufficiency. The majority of the patients [n = 82] benefited from surgery and were free of symptoms. This prospective study demonstrated that detailed clinical examination was sufficient to diagnose most patients suffering from primary varicose veins. Doppler vascular studies were useful in changing the treatment modality for those presenting with recurrent varicose vein or obese patients with signs and symptoms of chronic venous insufficiency with no clinically clear varicosity