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In peritoneal dialysis (PD) patients, fungi and Pseudomonas aeruginosa are considered important causative microorganisms for peritonitis with poor prognosis. Our objective was to explore expressions of membrane complement (C) regulators (CRegs) and tissue injuries in the peritoneum of patients with PD-related peritonitis, including fungal and Pseudomonas aeruginosa peritonitis. In peritoneal biopsy tissues obtained at PD catheter removal, we investigated the severity of peritonitis-associated peritoneal injuries and the expression of CRegs, CD46, CD55, and CD59 against peritoneal tissues without any episode of peritonitis. In addition, we evaluated peritoneal injuries among fungal and Pseudomonas aeruginosa-peritonitis (P1) and Gram-positive bacterial peritonitis (P2). We also observed deposition of C activation products such as activated C and C5b-9 and measured sC5b-9 in the PD fluid of patients. As a result, the severity of peritoneal injuries correlated inversely with the expression of peritoneal CRegs. Peritoneal CReg expression in peritonitis was significantly reduced compared to no peritonitis. Peritoneal injuries were more severe in P1 than in P2. CReg expression was further decreased and C5b-9 further increased in P1 than in P2. In conclusion, severe peritoneal injuries due to fungal and Pseudomonas aeruginosa-peritonitis decreased CReg expression and increased deposition of activated C3 and C5b-9 in the peritoneum, suggesting that peritonitis, particularly fungal and Pseudomonas aeruginosa-peritonitis, might induce susceptibility to further peritoneal injuries due to excessive C activation.

Outcomes of patients with end-stage renal disease at urgent dialysis initiation are varied, but evidence of their long-term prognosis is limited. We aimed to characterize patients undergoing urgent dialysis initiation and analyse its effect on survival outcome. We retrospectively identified 208 patients who began haemodialysis from 1 January 2012 to 31 December 2018 at our hospital. In this observational case–control study, the case group comprised patients starting urgent dialysis, and the control group comprised patients starting planned dialysis. We analysed laboratory data, sex, age, smoking history, comorbidities and presence of vascular access and nephrology care that potentially affected the outcome. Data were analysed with Kaplan–Meier curves of early and late period (3 years after dialysis initiation) survival and log-rank tests and with Cox regression analysis. Median age (range) at dialysis initiation was 73 (28–90) years, with 50 (24%) patients in the urgent initiation group. Five (10%) patients in this group had vascular access at dialysis initiation, whereas 21 (42%) had not received adequate pre-dialysis nephrology care. The estimated median overall survival rates of the urgent group and planned initiation group were 42 months and not reached, respectively (P = 0.0011). Multivariable analysis found urgent dialysis initiation to be an independent risk factor for survival (HR 2.36; 95% CI 1.36–4.00; P = 0.02). Survival was not significantly different between the groups for patients who continued chronic dialysis for > 3 years from dialysis initiation (P = 0.1339). The prognosis of patients starting dialysis in an urgent condition was poor compared with those who started planned dialysis.

The first line chemotherapy for advanced urothelial carcinoma is combination chemotherapy based on platinum. The optimal number of cycles for first line chemotherapy has not been defined yet. While cumulative toxicity of cisplatin can be a problem, the approval of pembrolizumab has changed the aspect of secondary treatment. We investigated 39 patients who were diagnosed with advanced urothelial carcinoma and treated with platinum-based chemotherapy between August 2009 and October 2018 in our hospital. We evaluated the correlation between number of cycles of first line chemotherapy and the survival rate of patients with advanced urothelial carcinoma. The primary tumor site was found in the bladder in 22 patients and in the upper urinary tract in 17 patients. Thirty one patients received cisplatin and 8 received carboplatin. Twelve patients received 2 or less cycles, 16 received 3 to 5 cycles and 11 received 6 or more cycles. The median overall survival in those populations was 5 months, 18 months, and 20 months, respectively. Patients who received 2 or less cycles showed significantly lower response rates to chemotherapy and the overall survival worsened. There was no significant difference in overall survival between patients who received 3 to 5 cycles and those who received more than 6 cycles. These results suggested that it may be excessive to continue the first line chemotherapy for more than 6 cycles.

Renal cell carcinoma has a propensity to metastasize to lung, bone, liver, brain, adrenal glands and the contralateral kidney. The proportion of metastatic RCC at diagnosis is estimated to be about 30–40%, and about 20–50% patients will develop metastasis after radical nephrectomy. Gallbladder metastasis from RCC is rare and is found in only about 0.6% of patients at autopsy.1 We present a case of metachronous metastasis of clear cell carcinoma to the gallbladder in a 55-year-old woman one year after radical nephrectomy.

Lipogranuloma is a rare inflammatory reactive process often reported to occur in the dermis and subcutis in the cosmetic surgery field.1 It very rarely occurs in the retroperitoneum. We present a case of retroperitoneal lipogranuloma mimicking metastases of renal cell carcinoma (RCC) after laparoscopic partial nephrectomy. A 63-year-old man who underwent laparoscopic left partial nephrectomy for RCC one year earlier had developed a left retroperitoneal tumor during postoperative surveillance. The tumor looked identical to an implant or recurrence of RCC on contrast-enhanced computed tomography (CT) and 18F-fluorodeoxyglucose positron emission tomography/CT. We resected the tumor, and pathology showed a lipogranuloma. Keywords: Lipogranuloma, Mimicking recurrence, Renal cell carcinoma

A 35-year-old man wasreferred to our hospital for treatment of a right adrenal tumor detected by ultrasonography during a physical check-up. Contrast-enhanced abdominal computed tomography revealed a poorly enhanced 74 mm tumor situated adjacent to the upper pole of the right kidney. The tumor consisted of fat with peripheral calcification. Magnetic resonance imaging also revealed a right retroperitoneal tumor with fatty contents and well-circumscribed capsule. The endocrine examination revealed the tumor as non-functioning. These findings were suggestive of a right adrenal myelolipoma. We performed laparoscopic right adrenalectomy because of its large size and malignant potency. The pathological examination revealed the retroperitoneal tumor asa mature teratoma existing apart from the adrenal gland. Primary retroperitoneal teratomasare relatively rare. Herein, we report thiscas e of adult mature teratoma occurring in the retroperitoneum.