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

acute scrotum: a review of 40 cases

To determine the relative importance of clinical presentation, laboratory studies, and ultrasonography in the diagnosis of acute scrotum, and to suggest an effective method of management. Subjects and Forty patients who were hospitalized between January 2002 and December 2002 for acute scrotum were studied with respect to history, physical examination, blood tests, urine analysis including culture, and scrotal ultrasonography with color Doppler study. Epididymitis [n = 24] was the commonest cause of acute scrotum followed by testicular torsion [n = 11], torsion of testicular appendages [n = 4], and idiopathic scrotal edema [n = 1]. Both mean age [40.7 vs. 13.8 years], and average duration of pain at presentation [4.5 days vs. 19.1 h] were higher in patients with epididymitis than in torsion. Onset was usually insidious in epididymitis, sudden in testicular torsion, and variable in torsion of testicular appendages. The majority [87.5%] of patients with epididymitis were managed conservatively. The testis was salvaged in 81.8% of patients with testicular torsion. The accuracy of ultrasonography was only 72.7% in testicular torsion, but was good in epididymitis. Our results show that a careful clinical evaluation, by an experienced examiner, provides the correct diagnosis in acute scrotum rather than ultrasonography. It is of utmost importance to exclude testicular torsion in those who are younger than 16 years and whose pain duration is less than 24 h