No abstract

Necrotizing fasciitis of the perineum and external genitalia is a life-threatening infective gangrene, primarily seen in adults. It may be seen at any age but it is relatively uncommon in children. Here, we report a case of Fournier's gangrene in a two year old male child who was treated aggressively with broad spectrum antibiotics and early surgical debridement with hemodynamic stabilization. Even though no obvious precipitating cause was identified, hygiene was thought to be the inciting factor. Early surgical debridement with appropriate antibiotics and aggressive supportive care gave good results.

Esophageal leiomyosarcoma is the commonest of all esophageal sarcomas but yet has a very low incidence. These tumors have been resected by the open approach so far. We describe the steps and challenges involved in the thoracoscopic excision of a huge leiomyosarcoma of the esophagus.

Background: It is now recognized that solid tumours encroach on the host's immune microenvironment to favour its own proliferation. Strategies to enhance the specificity of the endogenous T cell population against tumours have been met with limited clinical success. We aimed to devise a 2-tier protocol coupling in vivo whole antigen priming with ex vivo cellular expansion to clinically evaluate survival in patients following re-infusion of primed, autologous T cells, to determining treatment efficacy. Methods: Cancer cell lysate was administered intradermally once a month for 3 months, followed by twice-weekly for 3 weeks infusion of autologous CD8þ lymphocyte expanded ex-vivo. Post treatment tumor-specific T cell response and cytotoxicity was confirmed and evaluated for associations with survival status and duration. Results: There was significant increase in cytotoxicity exhibited by T cells measured using both Elispot and RTCA following treatment. Correlation analysis determined significant association between higher post treatment cytotoxicity scores and survival status (R ¼ 0.52, p ¼ 0.0028) as well as longer survival duration in months (R ¼ 0.59, p ¼ 0.005). Conclusions: Our treatment protocol successfully demonstrated significant correlation between tumor associated antigen specific immune response and objective prolongation of survival. Whole cell cancer antigen priming and adoptive T cell therapy is therefore a highly feasible clinical model which can be easily replicated to positively influence outcome in end-stage malignancy.Legal entity responsible for the study:

assess the nature of such lesions using endoscopic ultrasound (EUS) prior to a biopsy. Methods A total of 22 consecutive patients with portal hypertension who underwent an EUS evaluation between June 2008 and November 2011 for upper GI polypoid lesions found on endoscopy were included in the study. Procedure and pathology reports, obtained from patients' electronic records, were reviewed. Results Of the 22 patients (16 men, 6 women, median age 66) who underwent upper GI endoscopy, 11 had lesions in the proximal stomach (gastro-oesophageal junction, fundus, gastric body) while eight had lesions in the distal stomach (antrum, pylorus) and three in the duodenum. Six (27.3%) proved to be varices and 4 (18.2%) polypoid lesions over varices (2 benign, 2 malignant). Whereas, 7 (31.8%) patients had true polyps. The remaining lesions found on EUS included 1 (4.5%) case of gastric fold, 1 gastric antral vascular ectasia (GAVE), one ulcer, 1 case of external compression and one patient had a normal EUS with no lesion seen. Of the 10 cases of varices and varices underlying polypoid lesions, 8 (80%) were in the proximal stomach. Histology of non-vascular lesions under EUS were available in 11 patients, which showed 5 (45.5%) inflammatory polyps, 2 (18.2%) adenocarcinoma, 2 (18.2%) adenoma, 1 (9.1%) normal and one was reported as insufficient sample. Conclusion Indeterminate upper GI lesions encountered during routine endoscopy in patients with portal hypertension are commonly either varices or may develop around varices. We recommend EUS evaluation prior to biopsying such lesions in order to avoid potential serious complications such as iatrogenic variceal bleed.