Neuromuscular complications of immune checkpoint inhibitor therapy.

Immune checkpoint inhibitor (ICPI) therapy unleashes the body's natural immune system to fight cancer. ICPIs improve overall cancer survival, however, the unbridling of the immune system may induce a variety of immune-related adverse events. Neuromuscular immune complications are rare but they can be severe. Myasthenia gravis and inflammatory neuropathy are the most common neuromuscular adverse events but a variety of others including inflammatory myopathy are reported. The pathophysiologic mechanism of these autoimmune disorders may differ from that of non-ICPI-related immune diseases. Accordingly, while the optimal treatment for ICPI-related neuromuscular disorders generally follows a traditional paradigm, there are important novel considerations in selecting appropriate immunosuppressive therapy. This review presents 2 new cases, a summary of neuromuscular ICPI complications, and an approach to the diagnosis and treatment of these disorders. Muscle Nerve, 2018.

Transumbilical laparoendoscopic single-site surgery: more than 1-year experience in radical nephrectomy and its learning curve study.

PURPOSE: The aim is to report our 1-year experience in transumbilical Laparoendoscopic single-site (LESS) radical nephrectomy (LESS-RN) and assess its learning curve. PATIENTS AND METHODS: From September 2009 to December 2010, 18 consecutive patients with a solitary renal tumor underwent transumbilical LESS-RN. We grouped measured parameters on the basis of the first nine (group A) and last nine (group B) patients, and compared both subgroups with the control group (C), which was composed of the initial nine consecutive patients who underwent conventional laparoscopic RNs performed by the same surgeon. RESULTS: There was one LESS patient converted to conventional laparoscopic surgery for intraoperative hemorrhage and transfused. The mean for measured parameters of the groups A, B, C were: age: 58.6, 57.2, and 59.2 years, respectively (P>0.05); American Society of Aneshesiologists score: 1.9, 2.0, and 2.0, respectively (P>0.05); body mass index: 25.2, 23.5, and 23.1 kg/m(2), respectively (P>0.05); lesion size at CT scan: 5.0, 4.6, and 6.2 cm, respectively (P=0.039); operative skin to skin time: 191.6, 123.9, and 122.2 minutes, respectively (P=0.000); estimated blood loss: 172.2, 246.7, and 116.7 mL, respectively (P>0.05); incision length: 5.6, 5.9, and 7.4 cm, respectively (P=0.000); hospital stay: 5.8, 5.8, and 5.8 days, respectively (P>0.05). At the latest follow-up, all patients did not present any local recurrence or metastasis. CONCLUSIONS: In selected patients, the transumbilical LESS-RN can be safely performed with favorable outcomes. While a learning curve certainly exists, it appears to be short for an experienced laparoscopic surgeon.