Interdisciplinary three-step strategy to treat aortic stenosis and coronary artery disease in a patient with end-stage chronic obstructive pulmonary disease

Background: Valvular aortic stenosis is a common disease in the elderly, often in multimorbid patients. It is often associated with coronary artery disease and peripheral artery disease. In this situation, the risk of conventional open-heart surgery is too high, and other treatment strategies have to be evaluated. Case report: A 79-year-old female patient with severe aortic stenosis, coronary artery disease and end-stage chronic obstructive pulmonary disease suffering from dyspnea at rest and permanently dependent on oxygen was treated in three steps. Firstly, her pulmonary infection was treated with antibiotics for 7 days. Then, the left anterior descending artery was stented (bare-metal stent). In the same session, valvuloplasty of the aortic valve was performed. She was sent to rehabilitation to improve her pulmonary condition and took clopidogrel for 4 weeks. Finally, she underwent transapical aortic valve replacement. She was released to rehabilitation on postoperative day 12. Conclusion: A combination of modern interventional and minimally invasive surgical techniques to treat aortic stenosis and coronary heart disease can be a viable option for multimorbid patients with extremely high risk in conventional open-heart surgery

Human cytokine-induced killer cells have enhanced in vitro cytolytic activity via non-viral interleukin-2 gene transfer

Modulation of the immune system by genetically modified immunological effector cells is of potential therapeutic value in the treatment of malignancies. Interleukin-2 (IL-2) is a crucial cytokine which induces potent antitumor response. Cytokine-induced killer cells (CIK) have been described as highly efficient cytotoxic effector cells capable of lysing tumor cell targets and are capable of recognizing these cells in a non-MHC restricted fashion. Dendritic cells (DC) are the major antigen presenting cells. This study evaluated the antitumor effect of CIK cells which were non-virally transfected with IL-2 and co-cultured with pulsed and unpulsed DC. Human CIK cells generated from peripheral blood were transfected in vitro with plasmid encoding for the human IL-2. Transfection involved a combination of electrical parameters and a specific solution to deliver plasmid directly to the cell nucleus by using the Nucleofector(® )electroporation system. Nucleofection resulted in the production of IL-2 with a mean of 478.5 pg/10(6 )cells (range of 107.6–1079.3 pg /10(6 )cells/24 h) compared to mock transfected CIK cells (31 pg/10(6 )cells) (P = 0.05). After co-culturing with DC their functional ability was assessed in vitro by a cytotoxicity assay. On comparison with non-transfected CIK cells co-cultured with DCs (36.5 ± 5.3 %), transfected CIK cells co-cultured with DC had a significantly higher lytic activity of 58.5 ± 3.2% (P = 0.03) against Dan G cells, a human pancreatic carcinoma cell line

Endoscopic Carpal Tunnel Release using a modified application technique of local anesthesia: safety and effectiveness

<p>Abstract</p> <p>Background</p> <p>Local anesthesia is widely used for open carpal tunnel release. However, injection of local anesthesia as described by Altissimi and Mancini (1988) can interfere with endoscopic carpal tunnel release, by increasing the bulk of synovial layers and consequently result in worsening of the view.</p> <p>Purpose</p> <p>The purpose of this study was to evaluate the safety, efficacy using modified technique for application of local anesthesia.</p> <p>Methods</p> <p>33 patients suffering from gradual increasing symptoms of carpal tunnel syndrome. The patients were also asked to evaluate the pain associated with injection as well as tourniquet during surgery using Visual Analogue Scale (VAS) (ranging from 0 = no pain to 10 = maximum pain).</p> <p>Results</p> <p>One patient required additionally local anesthesia because of mild pain in the hand. The tourniquet was inflated for 13.00 (2.8 min). The pain score related to injection was 2.5 (0.8) and to tourniquet was 3.6 (0.9). Inflation of the tourniquet was well tolerated by all patients. Postoperative neurological sensory and motor deficits related to surgery and local blocks were not occurred.</p> <p>Conclusion</p> <p>Endoscopic release of the carpal tunnel syndrome in local anesthesia is effective, well tolerated and safe. This kind of application of local anesthesia did not reduce visibility.</p

Cytokine-induced killer cells are type II natural killer T cells

Background: Until now, cytokine-induced killer (CIK) cells were assumed to be part of the type I natural killer T (NKT) cell population, but it was not yet investigated if this is correct

Malignant melanoma in childhood

Maligni melanom je v otroški dobi zelo redka oblika malignega obolenja. Zanesljiva diagnoza pomeni izziv tako za kliniko kot za patohistologa. Čeprav oba postavita diagnozo melanom silno redko gre kljub vsemu nemalokrat v resnici za benigno pigmentno spremembo. Nekateri podatki in vprašanja v zvezi z melanomi v otroštvu so obravnavani v prispevku.Malignant melanoma in childhood is a very rare malignancy. The accurate diagnosis of melanoma in infants and children present a challenging problem for clinicians and pathologists. It is often "overdiagnosed". Some datas and questions are disscussed