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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.

透析患者のESA反応性には，炎症，栄養状態，二次性副甲状腺機能亢進症，鉄代謝の状態等のさまざまな背景が影響を及ぼすと考えられている．近年，hepcidin-25が造血反応での鉄利用障害の要因の一つであるとの報告もあるがメカニズムに関しては不明な点も多い．本研究では，エポエチンベータ（EPO）による貧血治療中の透析患者のうち，過去半年間に2回以上，血清フェリチン値が100ng/mL以上を呈した29名を対象とし，患者をヘモグロビン（Hb）低値群（10g/dL未満）ならびにHb高値群（10g/dL以上）の2群に層別して，造血・鉄関連指標および炎症マーカーの群間比較を行い，造血反応に影響を及ぼす要因を検討した．その結果，hepcidin-25およびフェリチンはHb低値群で有意に高く（Hb低値群vs. Hb高値群，hepcidin-25：74.7±48.8 vs. 40.1±24.5ng/mL，p＝0.018；フェリチン：257±148 vs. 140±61ng/mL，p＝0.007），Hb低値群ではCRPが高い傾向を示し（0.41±0.55 vs. 0.14±0.23mg/dL，p＝0.074），CRPとHbとの間に有意な負の相関が認められた．またHb低値群では網状赤血球比率（RET‰）が高い傾向を示したが（12.9±4.5 vs. 9.9±4.2‰，p＝0.083），Hb上昇には反映されていなかった（9.4±0.6 vs. 10.5±0.5g/dL，p＜0.001）．本研究の結果，フェリチン100ng/mL以上のHb低値の透析患者では，高フェリチン・高hepcidin-25状態による鉄の囲い込み，またRET‰，CRPが高値を示す傾向から赤血球寿命の短縮，微小な炎症が起こっている可能性があり，それらがESA低反応の原因となっている可能性が示唆された．

背景：二次性副甲状腺機能亢進症（SHPT）に対するマキサカルシトール（OCT）長期使用に関する報告は稀である．対象と方法：副甲状腺ホルモン（iPTH）が200pg/mLより高く，補正Ca（cCa）が11.5mg/dL未満の血液透析患者70例を対象とした．OCTは週3回，24週間投与された．OCT投与量は1週置きの最初の投与日のiPTHとcCaの値で調整された．24週での評価後，患者はSHPTに対するOCTまたはインターベンション治療が続けられた．約5年後，主治医へのアンケートにより患者の状態が評価された．結果：最初の24週間投与後に，31例（44.3％）でiPTHが200pg/mL以下になり，27例（38.6％）でiPTHが試験前の50％以下に減少した．11例に高Ca血症を認め，それは治療開始前のcCaと相関した（p＝0.0003）．予後調査では，27例が死亡，2例が腎移植を受け，2例が転院後不明であった．5例で副甲状腺摘除術が実施されていた．2006年12月末で，24週投与終了時と比較して，iPTHは有意に低下，cCaは有意に上昇，血清Pは変化を認めなかった．調査の直近6か月では，21例でOCT療法が維持されていたが，8例では中止されていた．この2群を比較した場合，2006年12月末の検査値ではiPTHのみに有意差を認めた．結語：これらの所見はある一部の症例においてはOCTの長期使用がSHPTの治療に有用であることを示唆している．

Purpose We retrospectively evaluated the outcome of Hautmann neobladder reconstruction in terms of complications, lower urinary tract symptoms, and sexual function in a large group of patients who underwent radical cystectomy. Methods We reviewed the medical records of 118 patients (105 men and 13 women) who underwent radical cystectomy and Hautmann neobladder construction at the Gifu University Hospital or one of its affiliate hospitals between Jan 1993 and Dec 1999. The 118 patients were asked to complete a questionnaire regarding lower urinary tract symptoms and sexual activity, and the data was compiled. Results The mean follow-up period was 50.4 months (range, 6.8-88.2). Early complications comprised wound infection (in 17.8% of patients) and ileus (in 10.1% of patients). Late complications comprised ileus, pyelonephritis, stone, and stricture of the pouch-urethral anastomosis, each of which occurred in 3.4% of patients. Eighty-one (73 men and 8 women, 72.9%) of 90 surviving patients replied to the questionnaire. Seventy-seven (95.1%) of these patients reported spontaneous micturition, whereas 4 (4.9%) patients required intermittent self-catheterization. The mean total I-PSS was 11.6 points. Twenty-five percent of patients experienced interrupted voiding almost always; 38% of patients did not experience this at all. Approximately 26% of patients experienced weak urinary streams; 36% did not. Daytime continence was achieved in 97.3% of patients; nighttime incontinence was present in 61.3%. Preoperatively, 79.7% of the men were capable of sexual intercourse. Postoperatively, 63.6% of men who underwent radical cystectomy with the nerve-sparing procedure were capable of sexual intercourse, whereas only 14.8% of men who underwent radical cystectomy without the nerve-sparing procedure were. Conclusions Morbidity rates were acceptable and functional outcome was excellent in this rather large group of patients who underwent Hautmann neobladder construction. Some problems have not been fully overcome, however, i.e., nocturnal incontinence and sexual dysfunction.

BACKGROUND Polyamine are recognized as cell growth factors. We studied in order to determine whether alterations in the levels of tissue and blood polyamines were useful biochemical markers for bladder tumor. METHODS The concentrations of three polyamines, diamine, spermidine and spermine, in urinary bladder and blood were determined during N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN)-induced bladder carcinogenesis in male F344 rats. At 5 weeks of age, rats were given 0.05% BBN in the drinking water for 20 weeks. RESULTS BBN induced bladder hyperplasia in 4 of 5 rats at 8 weeks, papillomas in 2 of 5 rats at 12 weeks, and transitional cell carcinoma in all the rats by 20 weeks. The levels of total polyamine in both bladder and blood of the rats during 12-20 weeks were significantly higher than those of the control animals given water alone. The elevation of total polyamine was mainly due to the increase of spermidine of the three polyamines, which was coincident with the incidence of bladder tumors. CONCLUSION The results indicated that the polyamines are excellent biochemical markers for bladder tumors.

BACKGROUND Polyamines are recognized as cell growth factors. We attempted to determine whether alterations in the levels of tissue and blood polyamines were useful biochemical makers for monitoring the efficacy of the chemotherapy for bladder tumors. METHODS The concentrations of three polyamines of diamine, spermidine and spermine in urinary bladder and blood were determined in male F344 rats with urinary bladder carcinoma induced by N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN), following chemotherapy with cisplatin, methotrexate and pirarubicin. RESULTS Bladder carcinoma was observed in 5 of 20 rats of the chemotherapeutic group, and 16 of 20 rats of the control group given saline alone. The levels of spermidine, spermine and total polyamine in both bladder and blood of the treated rats were significantly lower than those of the control rats. CONCLUSION The study suggested that the levels of tissue and blood polyamines could be used as biochemical markers for monitoring the efficacy of the chemotherapy for bladder tumors.

A 48-year-old female with the von Hippel-Lindau disease had the recurred renal cell carcinomas (RCCs) in the left remnant kidney after the right nephrectomy and partial resection of the left kidney due to the multiple RCCs. We performed radiofrequency ablation (RFA) under CT guidance for the treatment of that recurred tumor. As the tumors were adjacent to the descending colon, we injected the carbon dioxide gas (a dissection technique) during a radiofrequency ablation (RFA) procedure to displace the descending colon from the tumors. As a result, we were able to successfully achieve RFA for the recurred tumors without any complications including the intestinal thermal injury such as wall thickening or perforation. The patient survives well 5 months after RFA without the local recurrence. RFA in the solitary kidney is safe and effective treatment to preserve the remaining renal function, and the dissection technique using with carbon dioxide gas is also useful to avoid the thermal injury of the adjacent organs.

CAPD施行時に肉眼的血性排液を認めることは, 女性の生理に起因するものを除き比較的稀である. 今回我々は, 特発性腎破裂の腹腔内穿破により血性排液をきたし, 腎動脈塞栓術によりCAPDを中断することなく保存的に治癒せしめた1例を経験したので報告する. 症例は, CAPD歴1年2か月の30歳男性である. 打撲などの誘因はなく, 突然に左腰背部痛が出現し, 来院した. 受診時, 著明な貧血を呈し, CTにて巨大な左後腹膜血腫を認めた. 安静および輸血にても貧血は進行し, 同夜にはCAPD排液が血性となり, 左腎破裂の腹腔内穿破と診断された. 翌日施行した選択的左腎動脈造影にて, 左腎下極の腎内動脈末梢部の破裂を認めたため, スポンゼルによる腎動脈塞栓術 (TAE) を行い, 十分な止血効果が得られた. 術後は, ヘパリン入りの頻回バッグ交換にて, 凝血塊によるカテーテル閉塞を防ぎ, 腹膜クリアランス値や除水量などの腹膜機能に低下を認めることなくCAPDを維持することが可能であった. 血性排液の原因は多岐にわたり, 必ずしもCAPDや腎不全に直結するわけではないことを念頭において治療を進めることが肝要であると考えられた.

Objective To examine urinary CD44v6 total ribonucleic acid (RNA) expression in patients with bladder cancer using real-time quantitative reverse transcription polymerase chain reaction (qRT-PCR) and evaluate its potential as a novel marker of bladder cancer. Methods We used the bladder cancer cell line T24 and determined CD44v6 expression in cancer cells using in situ hybridization and immunohistochemistry. Subsequently, we obtained urine samples from 21 patients with bladder cancer and 25 patients without bladder cancer (controls). We extracted total RNA from the urine samples, measured CD44v6 total RNA expression in both groups using qRT-PCR, and compared the expression between groups. We also compared the sensitivity, specificity, and concordance rate between CD44v6 total RNA expression analysis by qRT-PCR and cytologic analysis, UroVysion fluorescent in situ hybridization, bladder tumor antigen identification, and nuclear matrix protein 22 measurements. Results We observed increased CD44v6 expression in bladder cancer cells using in situ hybridization and immunohistochemistry. CD44v6 total RNA expression was significantly higher in the urine samples of patients with bladder cancer than in those of controls. We calculated the cutoff value from the receiver operating characteristic curve and obtained sensitivity and specificity values of 85.7% and 72.0%, respectively, for qRT-PCR analysis. Conclusion Our results suggest that CD44v6 total RNA levels in urine can serve as a potential noninvasive biomarker of bladder cancer.

BACKGROUND Polyamines are recognized as cell growth factors. We attempted to determine whether blood polyamines are useful biochemical makers for monitoring the efficacy of the chemotherapy on bladder tumors. METHODS The blood concentrations of three polyamines, diamine, spermidine and spermine, were determined in 31 patients with invasive urinary bladder carcinoma, following chemotherapy with cisplatin, methotrexate and pirarubicin. Clinical response was evaluated by CT after 3 weeks. In 26 patients who underwent subsequent surgical therapy, the effectiveness of the chemotherapy were histopathologically evaluated by a pathologist according to the response criteria for bladder cancer treatment. RESULTS Mean regression rate in the size of the tumor after the chemotherapy was 40.8%. Of 31 patients, clinical CR was observed in 2, PR in 11, and NC in 18. Of 26 patients who were histopathologically evaluated, grade 3 was observed in 5, grade 2 in 4, grade 1b in 4, grade 1a in 12, and grade 0 in 1. One week after chemotherapy, the levels of spermine and total polyamine in the patients with CR and PR were significantly lower than those in the patients with NC. Similarly one week after chemotherapy, the levels of spermine and total polyamine in the patients with grade 3 and grade 2 were significantly lower than those in the patients with grade 1b, grade 1a and grade 0. CONCLUSION The study suggested that the levels of blood polyamines could be used as biochemical markers for monitoring the efficacy of the chemotherapy on bladder tumors.