[LAPAROSCOPIC LIVE DONOR NEPHRECTOMY WITH HORSESHOE KIDNEY: A CASE REPORT].

We performed laparoscopic live donor nephrectomy (LDN) on approximately 200 patients in Ehime Prefectural Center Hospital between 2003 and 2016. In 2016, a fifty-something woman who was a donor candidate for her husband was revealed to have a horseshoe kidney through contrast-enhanced computed tomography; other LDN procedures used a retroperitoneal approach, but this one used a transperitoneal approach since the latter approach allowed for a more favorable visual field. The left kidney was selected since renal scintigraphy showed equal bilateral renal function and renal arteries are simpler on the left side. The kidney was removed after the isthmus was successfully transected without ischemia. The opened calyx in the left kidney was sutured via bench surgery, and the kidney was transplanted to the recipient. Postoperative courses of both donor and recipient were good.

[FACTORS AFFECTING SHORT-TERM RENAL FUNCTION AFTER PARTIAL NEPHRECTOMY].

(Objectives) Recently, partial nephrectomy has been recommended for patients with T1 renal cell carcinoma to preserve renal function. In this study, we retrospectively investigated the factors that affect renal function after laparoscopic or robotic partial nephrectomy using cold or warm ischemia. (Patients and methods) We reviewed 105 patients who underwent laparoscopic or robotic partial nephrectomy between March 2006 and July 2016. Patients who had a single kidney were excluded. Thirty-nine patients were managed with cold ischemia, and 66 were managed with warm ischemia. Renal function was assessed using the estimated glomerular filtration rate (eGFR) and glomerular filtration rate (GFR) categories of the stage of chronic kidney disease (CKD). (Results) In the cold and warm ischemia groups, the duration of ischemia was significantly correlated with deterioration of the eGFR at 12 months postoperatively, but the duration of ischemia was not significantly correlated with exacerbation of the GFR categories for the stage of CKD in multivariate analyses. (Conclusions) These results suggest that the ischemia time may not have an impact on prognosis. However, due to the lack of deaths from renal carcinoma or cardiovascular events postoperatively in this study, the influence of each factor on overall survival or cardiovascular events could not be evaluated. More investigations are necessary to discern the acceptable level of deterioration and the corresponding clinical implications for postoperative eGFR.

[FEMALE PARAURETHRAL LEIOMYOSARCOMA: A CASE REPORT].

A 54-year-old woman visited another hospital with complaining of a palpable mass in vagina and dysuria. The mass had gradually enlarged since the past 2 years. Ultrasonography and CT revealed the tumor located between the urethra and vaginal mucosa. Histopathological examination was well-differentiated leiomyosarcoma from transvaginal needle biopsy. She was referred to our hospital. On MRI, the 4-cm tumor showed no infiltration into the vaginal mucosa or urethra. PET/CT showed a high uptake of FDG. No metastatic disease was evident. We performed excision of the tumor transvaginally. The tumor cells demonstrated immunoreactivity for estrogen receptors and partially progesterone receptors in histopathological examination. We speculated that the developmental mechanism of female paraurethral leiomyosarcoma was associated with female leiomyosarcoma in other surrounding pelvic organs.

[Port-Site Metastasis of Urothelial Carcinoma after Laparoscopic Nephroureterectomy: A Case Report].

The patient was a 70-year-old woman with a chief complaint of right hydronephrosis and hydroureter detected by ultrasound by a local doctor. She came to our hospital in January, 2014 for further examination. Because a tumor was discovered in her right upper ureter by computed tomography (CT) and retrograde pyelography, a right laparoscopic nephroureterectomy was perfomed on the suspicion of a right ureter carcinoma (clinical stage T2 N0M0). The pathological examination showed urothelial carcinoma, grade 3, pT3. She was followed up carefully without adjuvant chemotherapy. At 10 months postoperatively, a subcutaneous tumor was found at the port-site by CT, and she underwent surgical resection of the subcutaneous tumor. Pathological diagnosis was urothelial carcinoma, and was confimed to be portsite metastasis of urothelial carcinoma. She received three courses of gemcitabine and carboplatin chemotherapy therapy from November, 2014. She has been followed up without signs of recurrence.

[Seroma formation associated with expanded polytetrafluoroethylene graft used for dialysis access: a case report].

The patient was a 67-year-old man with end stage renal failure. Hemodialysis had been started in 1998. An expanded polytetrafluoroethylene (PTFE) graft was inserted into his left forearm and used for vascular access. He received a partial replacement of the expanded PTFE graft in September 2013. A seroma formed after this intervention and subsequently grew larger. He thus underwent seroma removal and bypass graft surgery. Four months after the surgery, to date, he remains free of seroma recurrence.

[Renal arteriovenous fistula with a vein aneurysm: a case report].

A 54-year-old woman presented with abdominal distension. Her medical history was unremarkable. Contrast-enhanced computed tomography (CT) revealed a left renal arteriovenous fistula and a large vein aneurysm, and she was diagnosed with aneurismal-type renal arteriovenous fistula. She was successfully treated with transcatheter arterial embolization using steel coils. Although she had pulmonary embolism as a serious post-operative complication, she recovered with anticoagulant therapy using heparin and warfarin. A contrast-enhanced CT scan performed 6 months after transcatheter arterial embolization did not show recanalization.

[Gangrene of the penis due to strangulation by a rubber band: a case report].

We report a case of strangulation of the penis by a rubber band. A 79-year-old man placed a rubber band tightly around the corona of his glans penis in order to prevent urinary incontinence. After five days, he was taken to our hospital in an ambulance for high temperature and general malaise. We found the rubber band and removed it immediately. Gangrene of the penis continued and he did not recover from sepsis, so we performed partial penectomy. After the operation, he completely recovered. Penile strangulation using a soft constricting object such as a rubber band might result in severe complications and we should be careful.

Mycotic aneurysm of the renal transplant artery.

A case of mycotic aneurysm secondary to septicemia is reported. A 59-year-old man with end-stage renal failure underwent renal transplantation from a living donor. On the fifteenth postoperative day, he was febrile and his arm around an entry wound of the drip infusion had infectious signs. Cultures of the blood and pus discharge grew Methicillin-resistant Staphylococcus aureus. Vancomycin was administered intravenously for 30 days. Then the existence of a mycotic aneurysm on the transplant artery was not suspected by computed tomography. After his infectious signs disappeared, examinations revealed a pseudoaneurysm measuring 4 cm in diameter at the site of anastomosis between the renal transplant and external iliac arteries by computed tomography. He has been carefully followed up with a conservative management. This is the first case of a mycotic aneurysm treated conservatively and displaying an uneventful course without rupture.

Extramedullary plasmacytoma arising from an adrenal gland.

Extramedullary plasmacytoma is a rare malignant neoplasm typically arising outside the bone marrow of patients who show no clinical evidence of multiple myeloma. We report a rare case of extramedullary plasmacytoma that was primarily found in a right adrenal lesion. Surgical excision and radiotherapy were performed for treatment of the primary lesion. Although laboratory examinations demonstrated the presence of M-protein and elevation of monoclonal IgG-lambda, a surgically excised mass revealed monoclonality of IgG-kappa. We therefore diagnosed extramedullary plasmacytoma independent of simultaneous benign M proteinemia, because the types of M-protein were quite different. One year after radiotherapy, no local recurrence was observed.