Great advances have been made in screening for and treatment of colorectal cancer (CRC), but recurrence rates remain high and additional therapies are needed. There is great excitement around the field of immunotherapy and many attempts have been made to bring immunotherapy to CRC through a cancer vaccine. Areas covered: This is a detailed review of the last decade's significant CRC vaccine trials. Expert commentary: Monotherapy with a CRC vaccine is likely best suited for adjuvant therapy in disease free patients. Vaccine therapy elicits crucial tumor infiltrating lymphocytes, which are lacking in microsatellite-stable tumors, and therefore may be better suited for these patients. The combination of CRC vaccines with checkpoint inhibitors may unlock the potential of immunotherapy for a much broader range of patients. Future studies should focus on vaccine monotherapy in correctly selected patients and combination therapy in more advanced disease.
We describe a case of double superior vena cava with a persistent left-sided superior vena cava discovered at the time of peripherally inserted central catheter (PICC) placement. The diagnosis was suggested by fluoroscopy and confirmed by venography. The relevance of the diagnosis with respect to PICC placement is discussed.
P elvic organ prolapse is a spectrum of anatomic abnormalities including rectocele, enterocele, rectal intussusception, rectal prolapse, and abnormal perineal descent, which cause significant morbidity. Pelvic discomfort, chronic drainage of blood and/or mucous from the anus, fecal incontinence, and constipation/ obstructed defecation symptoms are associated with prolapse of the pelvic organs. 1 the Women's health initiative reported that 41% of women ages 50 to 79 years showed some degree of symptomatic pelvic organ prolapse. in addition, ≈400,000 surgical procedures are performed annually, and 11% of women have an operative procedure for pelvic organ prolapse before the age of 80 years. 2,3 this article discusses the rationale for considering ventral mesh rectopexy as the standard for the surgical management of pelvic organ prolapse.
We present a case of pericardial effusion due to embolization of a fragment of an inferior vena cava (IVC) filter, with subsequent perforation of the right ventricle. This is a rare and unexpected cause of pericardial effusion. Fracture or embolization of IVC filters is a relatively uncommon complication, but these events may have serious clinical implications. Although IVC filters are often placed with the intent of removal, the device in many patients is never removed. The long-term implications of IVC filter placement must be kept in mind when making decisions about device placement and subsequent removal.
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