Immunotherapy of malignant disease using chimeric antigen receptor engrafted T cells.

Chimeric antigen receptor- (CAR-) based immunotherapy has been under development for almost 25 years, over which period it has progressed from a new but cumbersome technology to an emerging therapeutic modality for malignant disease. The approach involves the genetic engineering of fusion receptors (CARs) that couple the HLA-independent binding of cell surface target molecules to the delivery of a tailored activating signal to host immune cells. Engineered CARs are delivered most commonly to peripheral blood T cells using a range of vector systems, most commonly integrating viral vectors.

Mechanical chest compressions.

The authors of this study state that there is a lack of evidence about the efficiency of mechanical devices in producing chest compressions as an adjunct to resuscitation during cardiorespiratory arrest.

Consent for gynaecological procedure: what do women understand and remember?

Purpose: To determine patients' understanding and recall of consent information and risks associated with their procedure following gynaecological surgery.

Method: Patients planned for routine gynaecological surgery were invited to participate in the study by completing a self-administered questionnaire 4-6 h after day-surgery and 24 h after in-patient surgery. Collated data were analysed using standard statistical methods.

Cluster of neurological manifestations of rotavirus infection in children.

Rotavirus infection in children in the resource-rich countries is usually benign but complications are reported rarely. Four children presented within 4 weeks with neurological symptoms and stool virology positive for rotavirus. All four made a quick recovery and were discharged home after a few days without medication.

Understanding and recollection of the risks associated with cesarean delivery during the consent process.

Objective: To investigate women's recall of information provided during the consent process for cesarean delivery, specifically the associated risks, 24 hours after the procedure.

Methods: A prospective questionnaire-based study was conducted at the Barnet and Chase Farm Hospitals NHS Trust between May 2009 and August 2010. Women who had undergone a cesarean delivery (planned or emergency) completed a self-administered questionnaire 24 hours after delivery.

Risk of ionising radiation to trainee orthopaedic surgeons.

We undertook this study to determine the amount of scattered radiation received by the primary surgeon, assistant and patient during dynamic hip screw fixation for proximal femoral fractures. Data was collected from fifty patients. Five registrars were included as operating surgeon and four senior house officers as assistant surgeon.

An unusual case of incomplete Kawasaki disease in an adolescent returning from holiday in Montana.

Here we present an unusual case of incomplete Kawasaki disease in a 15-year-old boy returning from a holiday with his family in Montana. His symptoms were initial diarrhoea and lethargy, with fever, rash, conjunctivitis, and arthralgia developing during the course of his illness. His condition worsened while he was at his local hospital, and he was transferred to the regional tertiary paediatric hospital.

How to do it: the difficult thyroid.

There is a paucity of publications detailing how to deal with the difficult thyroid cancer. When compared to other cancers, it is relatively rare with several histopathological subtypes which run differing clinical courses and respond to different therapies. It is a condition predominately treated by specifically trained General and now ENT surgeons who already have a thorough knowledge of vocal fold assessment and rehabilitation as well as emergency airways management both to avoid and treat common complications should they occur.

An unusual groin exploration: De Garengeot's hernia.

De Garengeot's hernia is a rare surgical phenomenon and describes the presence of the vermiform appendix within a femoral hernia. We describe a case of acute appendicitis mimicking an irreducible femoral hernia and reiterate key operative techniques necessary to prevent post-operative morbidity associated with this pathology.

Factors associated with severe illness in pandemic 2009 influenza a (H1N1) infection: implications for triage in primary and secondary care.

Pandemic (H1N1) 2009 influenza virus (pH1N1/09) infection spread rapidly around the globe, leading to a phase 6 pandemic level of alert declared in June 2009. The WHO declared the end of the pandemic in August 2010. Although for the majority of infected patients, it manifest as a mild, self-limiting illness, a proportion appeared to follow an adverse clinical course, requiring higher level care and aggressive management strategies.

Treatment patterns in acute coronary syndrome patients in the United Kingdom undergoing PCI.

Aims: To evaluate practice patterns in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), focusing on the United Kingdom (UK).

Methods And Results: The Antiplatelet Therapy Observational Registry (APTOR) is a prospective observational study of consecutive ACS patients undergoing PCI (N=1525) from January-August 2007 in the UK, France, and Spain. In the UK, median time from hospital admission to PCI was one day post-admission (IQR 0,4) among STEMI patients and five days (IQR 2,9) among unstable angina/non-ST-segment elevation myocardial infarction (UA/NSTEMI) patients.

Techniques for removing rings from injured fingers.

Staff in emergency departments or minor injury units are sometimes asked to remove rings from patients' fingers. This is often because their presence has become painful or is preventing treatment of injuries or illnesses. Practitioners must be able to identify the tourniquet effect of rings or bracelets, and understand why and how they should be removed.

A complicated case of cholecystitis, listeriosis and HIV/AIDS.

A 37-year-old woman of Tanzanian origin presented with symptoms of cholecystitis, sepsis and oral candidiasis. Subsequent investigation found listeriosis and HIV infection. Effective use of the appropriate antibiotics and surgical management to remove the source of sepsis lead to a good recovery from the acute illness.

Is induced labour in the nullipara associated with more maternal and perinatal morbidity?

Purpose: To ascertain any differences in foetomaternal outcomes in induced and spontaneous labour among nulliparous women delivering at term.

Methods: A retrospective matched cohort study consisting of 403 nulliparous women induced at ≥ 292 days and 806 nulliparous women with spontaneous labour at 285-291 days.

Results: Compared to those in spontaneous labour, women who had induction of labour were three times more likely to have a caesarean delivery (OR 3.

The burden of uterine fibroids in five European countries.

Objective: To quantify the burden of uterine fibroids (UF) on health-related quality of life (HRQOL) and work productivity in a general population of women.

Study Design: Women diagnosed with or experiencing UF-related symptoms living in five Western European countries (France, Germany, Italy, Spain, and the United Kingdom) were identified through a cross-sectional Internet-based survey. The following parameters and outcomes of interest were captured and analysed: patient history and demographics, treatment and diagnosis patterns, symptom severity and HRQOL, work productivity and activity impairment, and disease or symptom-related health care resource use for the past year (e.

Management of vesico-urethral anastomosis disruption after radical prostatectomy.

Background/aims: Disruption of vesico-urethral anastomosis is a complication which can have dramatic results on the post-operative quality of life of the patient who has had radical prostatectomy. We present our own experience of this complication and discuss the aetiology, treatment and outcome with reference to published data on the subject. We suggest means by which to prevent this complication.

Isolated perforation of a duodenal diverticulum following blunt abdominal trauma.

Only 10% of duodenal diverticula are symptomatic. We present the case of a man who fell from a height of 6 ft, landing on his abdomen and presenting 4 h later with severe back pain and a rigid abdomen. At laparotomy, a perforated retroperitoneal duodenal diverticulum was found and repaired with an omental patch.

Clinico-pathological study of cervical polyps.

Objective: To determine the incidence of malignancy in cervical polyps and determine the effect of age and parity on clinical presentation.

Methods: A retrospective analysis of histological diagnosis and demographic information relating to 294 polyps was undertaken. Comparison was made between premenopausal and postmenopausal women as well as women with and without recurrent polyps.

Microscopy detection of rectal gonorrhoea in asymptomatic men.

This audit aimed to determine the usefulness of microscopy to detect presumptive rectal gonorrhoea (GC) infection in asymptomatic men. We retrospectively audited more than 400 male patients attending a London genitourinary medicine clinic from January 2005 to March 2007 who tested rectal culture positive for Neisseria gonorrhoeae and compared this with the microscopy detection rate. In total, 123/423 (29%) of culture positive samples were microscopy positive.