Development and Application of Mixed Vaccines in Renal Cell Carcinoma: Combining Autologous Tumor Cells with Dendritic Cells Derived from Autologous or Allogeneic Origin / 대한비뇨기과학회지

PURPOSE: To evaluate the effects of autologous tumor vaccine alone or in combination with dendritic cell vaccines, as a method of stimulating antigen-presenting cells in patients with a locoregionally confined renal cell carcinoma (RCC) or metastatic disease. MATERIALS AND METHODS: Twenty-seven patients with RCC pathological stages II to IV were treated with autologous tumor cell vaccine, either with or without dendritic cell vaccine. Interleukin 2 (IL-2) based immunotherapy was also applied to the patients with metastatic disease. Immunomagnetic beads were used to isolate CD14+ monocytes from patient or donor in dendritic cell preparations. IL-4 and granulocyte-macrophage colony stimulating factor (GM-CSF) were used for maturation of dendritic cells. Flow cytometry evaluations were performed for dendritic cell maturation and changes in the immunological profiles following our treatment. RESULTS: Both the isolation of CD14+ monocyte, using Immunomagnetic beads, and the maturation of dendritic cells, using IL-4 and GM-CSF stimulation, were effective. Tumor immunological profiles showed increased CD3 and CD56 populations after treatment. Side effects related with vaccine were minimal and tolerable. Patients were stratified by the purpose for the vaccination; 8 patients for post-nephrectomy adjuvant therapy and 19 for adjuvant immunotherapy of a metastatic disease. All 8 patients in the former showed a disease free state, while only one of the 19 in the latter group remained in complete remission, while 6 showed short-term responses. CONCLISIONS: Autologous RCC vaccine, combined with or without dendritic cell vaccine, might be effective in the suppression of tumor recurrence in locoregionally confined RCC, although a longer follow-up will be required. These vaccines should be further developed to reach their therapeutic purpose in metastatic RCC.

Posterior C1-2 Transarticular Screw Fixation in Atlantoaxial Instability

Posterior transarticular screw fixation is known to be one of the best surgical method for the atlanto-axial instability. Between April 1995 and February 1997, this technique was used in the treatment of 21 patients(10 men, 11 women) suffering from this condition. The average age at the time of operation was 39 years(range, 17 to 63). and mean follow-up period was 14(mean 3 to 25) months. The indication for fusion were nine cases, type II-A odontoid process fracture; three cases, type II-P odontoid process fracture; three cases, os odontoideum; three cases transverse ligament laxity due to rheumatoid disease; and three cases, transverse ligament injury without bone fracture. Eleven operations involved cases were operated with posterior C1, 2 transarticular screw fixation using a 3.5 mm cortical screw augmented th interlaminar iliac graft and sublaminar wire fixation. The other ten patients underwent the same surgery without sublaminar wire fixation. In two cases d screw were misplaced; one was placed lateromedially and the other caused widening of the joint capsule space, but there were corrected by reoperation. Patients were ambulated with Philadelphia neck collar on the first post-operation day. At the end of three months follow-up, bone union was seen in all cases, and the following conclusions may be drawn: 1) Immediately after surgery, ambulation is possible; 2) The rate of occurrence of bone union is high; 3) A halo vest is not needed; 4) Sublaminar wiring is also unnecessary.

Posterior Fixation and Interbody for Lumbar Spondylolisthesis

Sixteen consecutive patients with lumbar spondylolisthesis were treated with pedicular fixation and posterior interbody fusion. There were 8 isthmic and 8 degenerative types ranging in age from 39 to 68 years with a mean age of 52 years. The percentage of slippage averaged 28.5% preoperatively and 5.8% postoperatively in the isthmic type, 12.6% preoperatively and 6.6% postoperatively in the degenerative type. At 6 to 13 months postoperatively, all exhibited radiographic fusion. Clinical results were good in 13/16, fair in 3/16.

Surgical Treatment for the AVM Feeding Mainly from PCA

Among 51 intractanial AVM patients, 30 patients(58.8%) with AVM supplied mainly with PCA were studied for the relationship with feeding vessels, location and the size of AVM in connection with hemorrhage and also results in 20 surgical patients were analyzed. On cerebral angiogram, 56.7% accounted for AVM supplied only by PCA, 16.7% together with MCA and 26.6% with MCA and ACA. By location, 36.7% were for subcortical AVM and 63.3% were for deeply located paraventricular. 53.3% were large AVM and of them, 6.5% bleeded 30.0% accounted for small AVM, of which 88.9% bleeded. The total bleeding rate was high at 73.3%. Complete removal by surgery was available for 90.0%, and post operative improvement was at 75.0% with a mortality rate of 10.0%. 50.0% showed disappearance of seizure following total removal and 33.3% improved. 5.0%, however, had seizure for the first time following the surgery.

Posterior Approach for Cervical Spondylosis with Radiculomyelopathy

Of the 68 cervical spondyltic patients showing symptoms of radiculomyelopathy, assessments were made on 29 patients who underwent neural decompressive surgery with cervical laminectomy through posterior approach for the results of surgery. Analyses were also made on the anterior-posterior diameters of cervical canal on the plain film of cervical spine. The mean values of anterior-posterior diameters measured on the levels of cervical C3-7 were 16.5+/-1.83 mm in the normal adult and 7.3+/-1.08 mm in the cervical spondylotic patients with radiculomyelopathy, which is far narrower than that of the normal. In cervical spondylotic patients, the anterior-posterior diameters of directly upper and lower parts of the lesions were 11.9+/-1.20 mm and 12.1+/-1.61 mm respectively, also much narrower mean values than those of the normal control group. The results of the 29 patients who received cervical laminectomy by posterior approach were much improved for 51.7% and improved for 44.8%.