Report of case series: Correlation between pathological and radiological evaluation and clinical course of three cases of metastatic renal cell carcinoma with cytoreductive nephrectomy after combined immuno-oncology therapy.

Introduction: The pathologic evaluation and clinical course of cytoreductive nephrectomy after combined immuno-oncology therapy were reviewed to understand the benefits of cytoreductive nephrectomy. Case presentation: Three patients with clear cell carcinoma underwent tumor biopsy before combined immuno-oncology therapy. Case 1 was found to have a sarcomatoid component upon nephrectomy and continued with combined immuno-oncology therapy. Case 2 discontinued combined immuno-oncology therapy due to adverse events but maintained tumor shrinkage. The patient was found to have viable cells in most nephrectomy specimens but has had no recurrence after combined immuno-oncology therapy was discontinued. In case 3, the residual tumor was deemed resectable with combined immuno-oncology therapy, and nephrectomy and metastasectomy were performed. No viable cells were observed in either specimen, and the patient has had no recurrence. Conclusion: Cytoreductive nephrectomy after combined immuno-oncology therapy may be useful to allow pathologic evaluation of treatment and provide an indicator for subsequent treatment.

Recurrent multiple liver metastases of clear cell renal cell carcinoma with a significant response to sunitinib after nivolumab treatment.

Introduction: A case of multiple liver metastases of clear cell RCC with a significant response to sunitinib as the fifth line after nivolumab is reported. Case presentation: The patient was a 65-year-old man who underwent open nephrectomy for RCC. After the nephrectomy, he had recurrences several times, and metastasectomy had been performed for each recurrence. At 13 years after the nephrectomy, multiple liver, and lung metastases appeared. The treatment was switched to axitinib, followed by cabozantinib, then nivolumab. The best response was PR, SD, and PD for these three drugs, and treatment duration was 14, 3, and 3 months, respectively. As the fifth line, sunitinib was administered, with significant shrinkage of the multiple liver metastases, and PR has been maintained for 34 months. Conclusion: Sunitinib after an IO-drug showed a significant effect in spite of only slight efficacy with other VEGFR-TKIs, which may have occurred through the alteration of the immunological microenvironment.

Retroperitoneal hemorrhage in a patient with coronavirus disease 2019 (COVID-19):A case report.

INTRODUCTION: Early prophylactic administration of anticoagulants is recommended in patients with coronavirus disease 2019 (COVID-19). A case of retroperitoneal hemorrhage during inpatient treatment for COVID-19 is reported. CASE PRESENTATION: A 69-year-old man was diagnosed with COVID-19 6 days after symptom onset. After admission for difficulty of breathing, he was treated with steroid pulse therapy, remdesivir, and heparin sodium. On day 16 after admission, his hemoglobin and blood pressure dropped. Computed tomography showed a left retroperitoneal hematoma and multiple areas of extravasation in bilateral iliopsoas muscles. Anticoagulation therapy was stopped, and blood transfusion therapy was chosen by considering poor general condition caused by severe pneumonia. On day 19, the hemoglobin and blood pressure improved, and blood transfusion was stopped. However, he died on day 25 due to pneumonia. CONCLUSION: When retroperitoneal hemorrhage occurs as a complication of COVID-19, appropriate treatment decision, transcatheter arterial embolization or conservative treatment, should be chosen based on patient's condition. J. Med. Invest. 69 : 148-151, February, 2022.

Influence of surface treatment on bond strength of veneering ceramics fused to zirconia.

In all-ceramic restorations involving a zirconia framework, surface treatment of the zirconia surface is required to enhance bonding strength with the veneering ceramics and thus prevent chipping. The purpose of the present study was to investigate the influence of surface roughness and heat treatment of the zirconia and use of liner porcelain on bond strength between veneering ceramics and a zirconia framework. Debonding/crack-initiation strength (τb) was determined according to ISO 9693. No significant difference was observed among conditions, except with use of a liner under heat treatment, which yielded a τb of 26.0±2.9-28.9±1.7 MPa. Electron probe microanalysis revealed that components of the veneering ceramics remained on the zirconia surface after debonding, suggesting that fractures occur in the veneering ceramics and that improving the strength of the veneering ceramics themselves might increase bond strength.