Contralateral necrotizing fascitis after left nephrectomy for emphysematous pyelonephritis.

Introduction: Emphysematous pyelonephritis is an acute necrotizing infection of the renal parenchyma. The management is variable, extending to total nephrectomy in severe or refractory cases. Post-nephrectomy complications are numerous and common, necrotizing fasciitis, and sepsis being among them. Case presentation: We present a case of a 37-year-old woman with obesity and a previous left emphysematous pyelonephritis episode managed conservatively. The patient presented with a second left emphysematous pyelonephritis and underwent a left total nephrectomy. Two weeks later, the patient presented with a contralateral necrotizing fasciitis of the abdominal wall. Subsequently, the patient required several surgical debridement procedures and a vacuum-assisted closure system treatment. Conclusion: Emphysematous pyelonephritis is an aggressive infectious disease that requires high suspicion in patients at risk.

Radiological differential diagnosis and management of retroperitoneal hematomas posterior to radical inguinal orchiectomies. A case report.

Introduction: Retroperitoneal hematomas are rare complications of radical inguinal orchiectomy. This case report discusses their radiological differential diagnosis and management. Case presentation: A radical inguinal orchiectomy was performed on a 27-year-old patient. After discharge, he referred back pain. Computed tomography showed a retroperitoneal hematoma. A conservative approach was decided. Discussion: Traditionally, retroperitoneal hematomas have been considered possible radiologic pitfalls, which has therapeutical implications. This pitfall seems less likely in contemporary clinical practice.A conservative approach is preferred in stable patients, whereas active management should be offered to unstable patients. Conclusion: Future studies are necessary to offer evidence-based therapeutical options.

Ecm29-Dependent Proteasome Localization Regulates Cytoskeleton Remodeling at the Immune Synapse.

The formation of an immune synapse (IS) enables B cells to capture membrane-tethered antigens, where cortical actin cytoskeleton remodeling regulates cell spreading and depletion of F-actin at the centrosome promotes the recruitment of lysosomes to facilitate antigen extraction. How B cells regulate both pools of actin, remains poorly understood. We report here that decreased F-actin at the centrosome and IS relies on the distribution of the proteasome, regulated by Ecm29. Silencing Ecm29 decreases the proteasome pool associated to the centrosome of B cells and shifts its accumulation to the cell cortex and IS. Accordingly, Ecm29-silenced B cells display increased F-actin at the centrosome, impaired centrosome and lysosome repositioning to the IS and defective antigen extraction and presentation. Ecm29-silenced B cells, which accumulate higher levels of proteasome at the cell cortex, display decreased actin retrograde flow in lamellipodia and enhanced spreading responses. Our findings support a model where B the asymmetric distribution of the proteasome, mediated by Ecm29, coordinates actin dynamics at the centrosome and the IS, promoting lysosome recruitment and cell spreading.