Griffinbarrera0630

A 70-year-old female with metastatic clear cell renal cell carcinoma was treated with nivolumab. After three dosages, she developed interstitial lung disease which required steroid therapy and nivolumab was discontinued. Thereafter, the target lesion continued to shrinkand the best response was partial response 15 weeks after discontinuation of nivolumab, the reduction rate of which eventually reached 49.1%. Other immune-related adverse events (irAEs), nephrotic syndrome and acute kidney injury developed 34 weeks after discontinuation of nivolumab, leading to irreversible kidney injury that required chronic hemodialysis. Although the target lesion continued to shrink, a new lesion developed 48 weeks after discontinuation of nivolumab. Subsequently, targeted therapies were added, but she died of cancer 13 months after resuming medical treatment. In this case, although various irAEs developed, the effectiveness of nivolumab was sustained even after it was discontinued.Although bacteremia is often concomitant with severe urinary tract infection (UTI), the treatment outcome has not been well studied. The aim of this study was to verify treatment outcome in patients with bacteremia caused by UTI. We also assessed the efficacy of sequential oral antibiotics. According to a retrospective chart review of patients treated in the Sapporo Medical University Hospital from 2013 to 2016, bacteremia caused by UTI was observed in 59 patients. Intravenous antibiotics were sequentially converted to oral agents in 48 patients. Of them, 14 patients had recurrence after initial treatment. There was no significant difference in recurrence rate between events with and without conversion to oral antibiotics. Use of a steroid or immunosuppressant was significantly associated with recurrence of bacteremia caused by UTI. In patients with recurrence of UTI, treatment period was significantly long. In patients with bacteremia caused by UTI, antibiotic agents can be converted to a culture-directed oral antibiotic safely. However, we should notice the high risk of recurrence in patients treated with a steroid or immunosuppressant.Case 1 (42-year-old man) The patient was examined for penoscrotal swelling that had continued for 1 month. An annular erosive skin ulcer was observed at the penoscrotal base, with distal swelling. Asking the patient about the history of his condition was difficult due to a history of mental illness. We suspected his symptoms were due to an embedded foreign object. As computed tomography indicated the presence of a subcutaneous foreign object, surgery was performed to remove it. A rubber band was found wrapped twice around the area. After releasing the strangulation, penoscrotal swelling improved. Case 2 (72-year-old man) Penoscrotal swelling appeared after having an automobile tow hook attached to the penoscrotal base for 2 weeks. The patient was examined at the emergency room because he could not remove it on his own. A rescue squad was called, and they cut the strangulating object with an electric saw. After releasing the strangulation, penoscrotal swelling improved. Although we experienced 2 cases of penoscrotal strangulation involving strangulating objects with different characteristics, improvement was achieved in both by releasing the strangulation. The cases of penoscrotal strangulation reported in Japan with known strangulation type are reviewed.A 71-year-old man with gross hematuria and urinary retention showed a 7×8 cm polycystic mass compressing the prostate on the right ventral side on pelvic magnetic resonance imaging (MRI). The prostate specific antigen (PSA) level was 6.47 ng/ml. Prostate biopsy histopathology was consistent with prostate ductal carcinoma. Considering the difficulty of surgical therapy, endocrine therapy was undertaken prior to surgery for seven months. Almost all of the cyst disappeared ; robot-assisted laparoscopic radical prostatectomy was then successfully performed. Prostate ductal carcinoma is a relatively rare pathology for which radical prostatectomy plays an important role if the disease is localized. However, when ductal carcinoma involves large cysts, surgical treatment may be difficult. This report discusses the usefulness of neoadjuvant endocrine therapy to reduce the size of the cystic lesions.A 68-year-old man was diagnosed with prostate cancer (initial serum prostate specific antigen [PSA] 389 ng/ml, stage cT4N1M1c, Gleason score 5+4), and androgen deprivation therapy was initiated. Despite the low serum PSA level, he developed postrenal acute kidney failure 4 years later, with progression of prostate cancer and liver and lung metastases. Serum levels of neuron-specific enolase and pro-gastrinreleasing peptide (tumor markers) were elevated. He underwent re-biopsy of the prostate, and histopathological examination revealed small cell carcinoma. He was initially treated with carboplatin and etoposide therapy. Liver metastases showed partial remission, and serum tumor marker levels were temporarily reduced. However, disease progression was observed after 4 chemotherapy cycles, and he was then treated with an 8-cycle course of amrubicin. Metastases showed shrinkage, and serum tumor marker levels were reduced after 2 chemotherapy cycles. Tumor enlargement recurred after 8 cycles, and the patient is being treated with palliative therapy. Amrubicin therapy may be effective in the treatment of small cell carcinoma of the prostate.A 67-year-old female presented for evaluation of a left inguinal mass. Contrast-enhanced computed tomography revealed a tumor surrounding the urethra. Magnetic resonance imaging showed that the tumor had invaded the bladder neck on the anterior aspect of the urethra. The serum carbohydrate antigen 19-9 level was elevated. The clinical diagnosis was a primary adenocarcinoma of the female urethra (cT4N2M0). The initial treatment consisted of gemcitabine plus cisplatin (GC) and oral fluoropyrimidine (S-1). A total cysto-urethrectomy with anterior vaginal wall resection, pelvic and inguinal lymphadenectomy, and urinary diversion with ileal conduit formation were performed. The final diagnosis was urethral adenocarcinoma (ypT4ypN2, stage IV). Twelve months post-operatively, there was no evidence of recurrence or distant metastases.Chemotherapy and immune-checkpoint inhibitors, used as second-line treatments for advanced urothelial cancer (UC), can have adverse effects in some patients, such as decreased organ function. We investigated the effectiveness of cooperation with medical/welfare services, so-called cooperative medicine, in these cases. A total of 137 UC patients who had undergone second-line therapy were analyzed. Of these 137 patients, 49 were categorized in the "cooperative"treatment group, in which a general practitioner performed blood tests and transfusions ; and, administered medication, while nurses and case workers from a community health care institution provided mental and social support. There were 50 in the "joint" treatment group, who were treated jointly by a urologist and general practitioner ; and, 38 in the "solo" treatment group who were treated by a urologist only. The Short Form Health Survey, SF-36, was used to evaluate quality of life (QoL). We observed that the overall survival after the second-line treatment was significantly longer in the cooperative group than in the other two groups, with multivariate analyses confirming cooperative treatment as a significant factor for better prognosis (P=0.005). The period of second-line treatment in the cooperative group was significantly longer (P=0.003) than that in the solo group, whereas the proportion of patients who subsequently received third-line treatment was higher in the cooperative group, 58. 5%, than in the solo and joint groups, 26. 5% and 25. 5%, respectively. Posttreatment QoL measurements in the joint and solo groups were significantly lower for 3 and 6 items, respectively, whereas there was no appreciable decrease in post-treatment QoL measurements in the cooperative group. Multivariate analysis showed that cooperative treatment was particularly beneficial for female patients ≥75 years of age, and patients with status 2 performance.This article highlights publications in Enviromental Microbiology and Microbial Biotechnology papers about antibiotic resistance. It concludes that the One health approach is basic to addressing this problem.Crested geckos (Correlophus ciliatus, formerly Rhacodactylus ciliatus) were rediscovered in New Caledonia 25 years ago and despite being common in the pet trade, there is no published information on their physiology. We measured thermoregulation (preferred body temperature, thermal set-point range, and voluntary limits) and performance (thermal performance curves [TPC] for 25 cm sprint speed and 1 m running speed) of adult and juvenile crested geckos in the laboratory to describe their thermal tolerances, differences among life stages, correlations between behavior and performance, and correlations with natural temperatures. Despite lacking special lighting or heating requirements in captivity, crested geckos displayed typical thermal biology for a lizard with no difference among life stages. They thermoregulated to a narrow set-point range (TSET , 24-28°C), that broadly overlaps natural air temperatures in New Caledonia, during activity. Somewhat surprisingly, the optimal temperature for performance (TOPT , 32°C) was substantially above preferred body temperatures and approximated the average maximum temperature voluntarily experienced (VTMAX , 33°C). Preferred body temperatures, by contrast, corresponded to the lower threshold temperature (Td ) where the TPC deviated from exponential, which we suggest is the temperature where performance is optimized after accounting for the costs of metabolic demand and overheating risk. Our results demonstrate that despite their lack of specific requirements when housed in human dwellings, crested geckos actively thermoregulate to temperatures that facilitate performance, and have thermal biology typical of other nocturnal or shade-dwelling species. Additionally, crested geckos appear at little risk of direct climate change-induced decline because increased temperatures should allow increased activity.Objectives To evaluate postoperative pain and esthetic outcomes in patients undergoing transumbilical laparoscopic adrenalectomy with wound closure using 2-octyl cyanoacrylate. Methods A total of 26 patients who underwent laparoscopic adrenalectomy with the transumbilical approach and agreed to participate in this study were included. Patients were randomly divided into two groups the 2-octyl cyanoacrylate group (Glue group) or the non-use group (non-Glue group). A single surgeon (AM) carried out all procedures between 2014 and 2017. Results There were no significant differences in the clinical background of the Glue and non-Glue groups. The number of patients with moderate or high levels of pain in the resting/moving period on postoperative days 1, 2 and 3 was 6/10 (46%/77%), 6/9 (46%/69%) and 3/5 (23%/38%) in the non-Glue group, and 5/7 (38%/54%), 2/7 (15%/54%) and 1/3 (8%/23%) in the Glue group. These differences were not significant. In the subgroup analysis of patients aged less then 50 years, the numbers were 4/6 (57%/86%), 5/7 (71%/100%) and 3/5 (43%/71%) in the non-Glue group, and 3/4 (33%/44%), 1/4 (11%/44%) and 0/1 (0%/11%) in the Glue group in the resting/moving period.