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Background: High-risk non-muscle invasive bladder cancer (NMIBC) is thought to be associated with a higher risk of recurrence and progression. A recent study revealed that a high De Ritis ratio was a risk factor in some solid malignancies. This study examined the importance of the De Ritis ratio as a prognostic marker in high-risk NMIBC. Materials and Methods: A total of 138 patients who were initially diagnosed with high-risk NMIBC between January 2012 to December 2016 were enrolled in this study. The criteria for the high-risk classification followed the EAU guidelines. The recurrence-free and progression-free survival of the higher and lower De Ritis ratio groups were compared. The cut-off value of the De Ritis ratio was set at 1.35, based on a receiver operator curve analysis. Results: The median observation period was 50.3 months. Among these patients, 32 (23.1%) patients developed recurrent disease and 15 (10.9%) patients showed progression. A multivariate analysis revealed that non-BCG treatment was an independent risk factor for recurrence, and a higher De Ritis ratio was an independent risk factor for cancer progression. Conclusions: The De Ritis ratio might be a risk factor for progression in high-risk NMIBC.

Hypogenesis or agenesis of right hepatic lobe is a rare abnormality and is generally associated with gallbladder and biliary tract abnormalities. Cases of biliary injury following cholecystectomy have been reported in patients with agenesis of right hepatic lobe because the anatomical anomalies complicate the surgical approach. We report a case of laparoscopic cholecystectomy in a patient with hypogenesis of right hepatic lobe. A 92-year-old male patient was admitted to our hospital with fever and right lower abdominal pain with suspected acute appendicitis. Abdominal computed tomography revealed gallstones with acute cholecystitis and hypogenesis of right hepatic lobe. He underwent laparoscopic cholecystectomy with the left semilateral decubitus position. The patient's postoperative course was uneventful. In conclusions, some patients with liver lobe hypoplasia do not present with the typical symptoms of acute cholecystitis due to dislocation of the gallbladder. The left semilateral decubitus position with modified placement of port sites is useful for laparoscopic cholecystectomy in patients with hypogenesis of right hepatic lobe.

Objective: To evaluate longitudinal changes in parotid volumes and saliva production over 2 years after 30 Gy irradiation. Methods: We retrospectively evaluated 15 assessable patients treated for advanced oral cancer. Eligibility criteria were a pathologic diagnosis of squamous cell carcinoma, preoperative radiation therapy with a total dose of 30 Gy delivered in 15 fractions, and the availability of longitudinal data of morphological assessments by computed tomography and functional assessments with the Saxon test spanning 2 years after radiation therapy. In the Saxon test, saliva production was measured by weighing a folded sterile gauze pad before and after chewing; the low-normal value is 2 g/2 min. Repeated-measures analysis of variance with Bonferroni adjustment for multiple comparisons was used to determine the longitudinal changes. Results: The normalized ipsilateral parotid volumes 2 weeks and 6-, 12- and 24 months after radiation therapy were found to be 72.5, 63.7, 66.9 and 78.1%, respectively; the normalized contralateral volumes were 69.8, 64.6, 72.2 and 82.0%, respectively. The bilateral parotid volumes were significantly decreased after radiation therapy (P , 0.01). The nadir appeared at 6 months post-radiation therapy and the volumes substantially recuperated 24 months after radiation therapy (P , 0.01). Mean saliva production before radiation therapy was 3.7 g; the longitudinal changes after radiation therapy were 31.3, 38.0, 43.3 and 69.6%, respectively. Substantial recuperation of saliva production was observed 24 months after radiation therapy (P ¼ 0.01). Conclusions: Although parotid volumes and saliva production were decreased after 30 Gy irradiation, we observed the recuperation of morphological and functional changes in the parotid glands 2 years after radiation therapy.

To determine the appropriate management of adrenal hemorrhage in patients with severe chest and upper abdominal blunt trauma.We reviewed 7 patients who suffered from severe traumatic adrenal hemorrhage after a traffic accident (n = 4) or fall (n = 3). Contrast-enhanced CT images were analyzed for multi-organ traumatic injury, hematoma size, extravasation, and pseudoaneurysm formation. We also report their management including transarterial embolization (TAE) and follow-up findings.All 7 patients manifested multi-organ traumatic injury and hemothorax; 5 also had rib fractures, 5 had abdominal organ injuries (liver, n = 3; kidneys, n = 2; pancreas, n = 1); 2 had dorsal fractures, and 1 had a traumatic aortic aneurysm. On CT images, unilateral right adrenal hematomas ranging from 20 to 50 mm (mean 26 mm) in length and from 15 to 50 mm (mean 23 mm) in width were seen. In 6 patients these were localized, and they were followed without any intervention. The other patient had a massive hematoma with pseudoaneurysm and extravasation, who subsequently received TAE. At 3-month follow-up all patients were doing well.Information regarding the size of the hematoma and the presence of extravasation helps to select the appropriate management of patients with traumatic adrenal hemorrhage. TAE appears to be useful for treating patients with massive adrenal hemorrhage.