Tumors evade T cell-mediated rejection despite the presence of tumor associated antigens (TAAs) and T cells specific for these TAAs in cancer patients. Therapeutic tumor vaccines are being developed ...to prevent this evasion. Previous reports revealed that anti-tumor T cell responses could be activated in mice when granulocyte macrophage-colony stimulating factor (GM-CSF) or CD40L are produced at tumor vaccine sites. We sought to test the hypothesis that production of GM-CSF and CD40L by a bystander cell line could induce an anti-tumor T cell response in an
in vitro human model.
The K562 cell line was stably transfected with the human
GM-CSF and
CD40L genes. The effect of this cell line on T cell responses was tested in a human autologous mixed tumor cell/lymph node cell model using tissue from a series of cancer patients.
There was no significant anti-tumor T cell response when human lymphocytes derived from tumor-draining lymph nodes were stimulated with autologous tumor cells
in vitro. However, significant anti-tumor T cell responses were observed when bystander cells transfected with
CD40L and
GM-CSF were added to the cultures.
A fully autologous human model consisting of tumor cells as stimulator cells and tumor-draining lymph nodes as responder cells can be used to test immunotherapeutic strategies. T cells in these lymph nodes are unresponsive to autologous tumor cells, but this lack of responsiveness can be reversed in the presence of GM-CSF and CD40L. These data provide a rationale for testing tumor cell vaccines incorporating GM-CSF- and CD40L-expressing bystanders in clinical trials.
BACKGROUNDIntraoperative ultrasonography has proven to be a useful tool for tumor identification during robot-assisted laparoscopic partial nephrectomy (RALPN). However, its utility is limited in ...renal tumors that are completely endophytic and isoechoic in nature. We present a novel approach to intraoperative tumor identification using preoperative percutaneous intratumoral embolization coil placement that may be utilized in the management of such cases. CASE PRESENTATIONA 42-year-old Caucasian male was referred with an incidentally discovered right renal mass that was posterior and completely endophytic. He desired a RALPN; however, preoperative renal ultrasound demonstrated an isoechoic lesion. Thus, the patient underwent preoperative image-guided placement of an embolization coil within the tumor. This facilitated identification of the tumor intraoperatively using intracorporeal ultrasound centered on the coil and enabled resection with negative margins. CONCLUSIONUtilizing a novel approach analogous to preoperative localization of other solid malignancies, such as breast cancer, we were able to effectively identify and resect an isoechoic renal mass during RALPN.
Objective: To characterize urodynamic changes among patients who underwent a continent urinary reservoir (Florida Pouch).
Methods: Patients who had a continent urinary diversion performed between ...January 1988 and December 1991 were asked to undergo sequential urodynamic evaluation to compare early (≤24 mo) versus late (>24 mo) changes in reservoir function. The difference in reservoir function was evaluated by defining change in maximum enterocystometric capacity of ≥100 mL, changes in pressure of 5 cm H
2O, changes in segmental contractions were ≥3. High pressure contractions were those ≥30 mm H
2O.
Results: Seventeen patients underwent sequential urodynamic evaluation. The mean timing of the early study was 12.2 months (range 3–24 mo). The mean timing of the late study was 47.1 months (range 30–58 mo). The mean capacity of the reservoir initially was 698 mL (range 474–1000 mL). On long-term study the mean was 793 mL (range 400–1000 mL). The capacity remained unchanged or increased in 88% of patients. The pressure within the reservoir remained unchanged in seven patients, decreased in eight, and increased in two. Segmental contractions originally occurred in 15 patients with 11 low pressure and 4 high pressure type contractions. On long-term evaluation, 13 patients demonstrated contractions with 10 low pressure and 3 high pressure in character. Of note, 75% of those with initial high pressure contractions had no (1) or low pressure (2) contractions on subsequent evaluation.
Conclusion: In long-term urodynamic evaluation of the continent urinary reservoir the reservoir capacity remained unchanged or increased in 88% of patients, while reservoir pressure remained unchanged or decreased in 88%. This long-term evaluation, therefore, demonstrates the continent urinary reservoir to be a low pressure system of adequate capacity thereby minimizing the risk of reflux.
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