[A Case of Chromophobe Renal Cell Carcinoma Producing Interleukin-6 with Stauffer Syndrome].

A 41-year-old male consulted a local doctor with fever and left flank pain. He was introduced to our hospital for a left renal mass detected by ultrasonography. Blood analysis revealed elevated white blood cell count, C-reactive protein, bilirubin and aspartate transaminase. Computed tomography demonstrated a left renal mass (expansive growth), which was 11 cm in maximum diameter and enhanced moderately at the corticomedullary phase. Neither distant metastasis, infectious findings nor hepatobiliary abnormalities were observed. The patient underwent laparoscopic radical nephrectomy with a clinical diagnosis of non-clear cell renal cell carcinoma cT2bN0M0 with Stauffer syndrome. The surgery required 186 minutes of insufflation, and estimated blood loss and specimen weight were 44 ml and 695 g, respectively. There were no complications. Histopathological diagnosis was chromophobe renal cell carcinoma-classic pattern (ChRCC-C), which was producing interleukin-6 in the tumor cytoplasm immunohistochemically. Postoperatively, there was early defervescence with complete resolution of the Stauffer syndrome. No relapse or liver dysfunction has occurred at 5 years after operation. To our knowledge, this is the first reported case in the literature of ChRCC accompanied by Stauffer syndrome.

Generation and characterization of a genetically modified live rabies vaccine strain with attenuating mutations in multiple viral proteins and evaluation of its potency in dogs.

Live rabies vaccines have advantageous features that can facilitate mass vaccination for dogs, the most important reservoirs/transmitters of rabies. However, some live vaccine strains have problems in their safety, namely, risks from the residual pathogenicity and the pathogenic reversion of live vaccine strains. The reverse genetics system of rabies virus provides a feasible option to improve the safety of a live vaccine strain by, for example, artificially introducing attenuating mutations into multiple viral proteins. It was previously demonstrated in separate studies that introduction of amino acid residues Leu at position 333 in the viral glycoprotein (G333), Ser at G194, and Leu/His at positions 273/394 in the nucleoprotein (N273/394) enhance the safety of a live vaccine strain. In this study, to test our hypothesis that combinational introduction of these residues would significantly increase the safety level of a vaccine strain, we generated a novel live vaccine candidate, ERA-NG2, that is attenuated by mutations at N273/394 and G194/333, and we examined its safety and immunogenicity in mice and dogs. ERA-NG2 did not cause any clinical signs in mice after intracerebral inoculation. After 10 passages in suckling mouse brains, ERA-NG2 retained all of the introduced mutations except the mutation at N394 and the highly attenuated phenotype. These findings indicate that the ERA-NG2 is highly and stably attenuated. After confirming that ERA-NG2 induced a virus-neutralizing antibody (VNA) response and protective immunity in mice, we immunized dogs intramuscularly with a single dose (105-7 focus-forming units) of ERA-NG2 and found that, at all of the tested doses, the strain induced a VNA response in dogs without inducing any clinical signs. These findings demonstrate that ERA-NG2 has a high level of safety and a substantial level of immunogenicity in dogs and thus is a promising live vaccine candidate that can facilitate vaccination in dogs.

Ureteral Diaphragmatic Hernia Treated with Ureteral Stenting: A Case Report and Review of the Literature.

Ureteral diaphragmatic hernia through diaphragmatic defects is an exceptionally rare subset of ureteral hernia with only fourteen such cases reported in English manuscripts. An 85-year-old woman was introduced to our department with right flank pain, fever elevation, and nausea. Urinalysis showed bacteriuria, and Escherichia coli was detected in the urine culture. Blood analysis revealed abnormal findings, including elevated WBC count (10,510/µl) and C-reactive protein (0.28 mg/dl). Computed tomography (CT) of the abdomen demonstrated a defect of the right diaphragmatic crus containing a dilated right ureter with associated hydronephrosis. Retrograde pyelography showed hydronephrosis and dilated ureter loops through the defect of diaphragmatic crus, known as a "curlicue sign," and the diagnosis was right ureteral diaphragmatic hernia. A ureteral stent was placed on her right side, and the ureter was reducted into the retroperitoneal space. After six months, the ureteral stent was removed, with no subsequent recurrence of the ureteral diaphragmatic hernia at seven months. We reviewed all cases in the literature published in English of ureteral diaphragmatic hernia. While the etiology of ureteral diaphragmatic hernia is unknown, our present case and previous reports suggest that a ureteral diaphragmatic hernia may occur due to hepatic atrophy and/or an elevated position of the right kidney.

[Retroperitoneal Dedifferentiated Liposarcoma with Metaplastic Bone Formation : A Case Report and Review of the Literature].

A 69-year-old female was introduced to our department for a retroperitoneal mass, 25 mm in diameter, in the right perirenal space indicated by computed tomography (CT). On the basis of magnetic resonance imaging (MRI), retroperitoneal soft tissue sarcoma was suspected. Because she rejected surgical treatment, we continued imaging surveillance. Subsequently, the mass grew larger, but her intention did not change. At 21 months after initial consultation, CT revealed further increase of the above mass and a new lesion with calcification. Ultimately, she underwent mass resection with concomitant resection of the right kidney. Histological examination showed dedifferentiated liposarcoma with metaplastic bone formation and positive surgical margin, but she refused adjuvant chemotherapy. She has survived 7 months since the operation with no evidence of recurrence.

[Laparoscopic Pyelolithotomy in a Horseshoe Kidney : A Case Report and Review of the Literature].

A 76-year-old man was introduced to our department with a right kidney stone. On the basis of further examination, he was diagnosed with a 23 mm right kidney stone accompanied with a horseshoe kidney. Retrograde pyelography and diuretic renogram revealed a non-obstructed right ureteropelvic junction. Finally, we chose laparoscopic pyelolithotomy via peritoneal approach because the stone was large and accompanied with a horseshoe kidney. The surgery took 165 minutes and the estimated blood loss was 25 ml. There were no minor or major complications. Because horseshoe kidney has anatomical abnormalities, it seems to be necessary to consider a different treatment strategy from that of an upper urinary tract stone in a healthy kidney. We assume that laparoscopic pyelolithotomy is an effective and safe procedure for renal pelvic stones in the case of a horseshoe kidney.

[Liposarcoma of the Spermatic Cord : A Case Report and Review of the Literature].

A 92-year-old man had noticed enlargement of a mass in the right scrotum and inguinal region for nine months. The patient was introduced to our department for right testicular tumor. Physical examination showed an over fist-sized, hard mass in the right scrotum. Magnetic resonance imaging (MRI) showed the mass, which consisted of fatty and solid contents. In addition, MRI revealed a bladder tumor simultaneously. Computed tomography revealed no distant metastases. The patient underwent right high orchiectomy with the mass resection and transurethral resection of the bladder tumor (TURBT). Pathological examination revealed well- and dedifferentiated liposarcoma of the right spermatic cord, and urothelial cancer of the bladder. Liposarcoma of the spermatic cord is a rare neoplasm. To the best of our knowledge, the present case was the 114 th reported case and oldest in Japan.

Genetic diversity of feline morbilliviruses isolated in Japan.

Feline morbillivirus (FmoPV) is an emerging virus in domestic cats and considered to be associated with tubulointerstitial nephritis. Although FmoPV was first described in China in 2012, there has been no report of the isolation of this virus in other countries. In this report, we describe the isolation and characterization of FmoPV from domestic cats in Japan. By using reverse transcription (RT)-PCR, we found that three of 13 urine samples from cats brought to veterinary hospitals were positive for FmoPV. FmoPV strains SS1 to SS3 were isolated from the RT-PCR-positive urine samples. Crandell-Rees feline kidney (CRFK) cells exposed to FmoPV showed cytopathic effects with syncytia formation, and FmoPV N protein was detected by indirect immunofluorescence assays. In addition, pleomorphic virus particles with apparent glycoprotein envelope spikes were observed by electron microscopy. By sequence analysis of FmoPV H and L genes, we found that FmoPVs showed genetic diversity; however, signatures of positive selection were not identified.

[A case of renal malacoplakia that was difficult to distinguish from cystic renal cell carcinoma].

A 66 years old man visited our hospital with a chief complaint of right flank pain and abdominal palpable mass. Abdominal enhanced computed tomography scan showed a large cystic mass with infiltrating surrounding tissue in the right kidney. We diagnosed it infected cystic renal cell carcinoma because of high grade fever and acute inflammatory response. It was surgically unresectable tumor. Therefore, percutaneous puncture and drainage was performed under ultrasound guidance. In the culture of drainage fluid, Escherichia coli (E. coli) was isolated. Then, we confirmed reduction in the size of the tumor, right radical nephrectomy was performed. Because of tumor invasion to ascending colon, we performed the excision of right kidney together with ascending colon. Histological study confirmed target-shaped Michaelis-Gutmann body, and the definitive diagnosis was malacoplakia of the kidney. We reported a case of renal malacoplakia that was difficult to distinguish from cystic renal cell carcinoma. Our case is 12th case of renal malacoplakia in the Japanese literature.

[A case of emphysematous cystitis treated by clean intermittent catheterization : a case report].

Emphysematous cystitis is a rare condition characterized by air formation in and around the bladder wall by gas-forming organisms. An 89-year-old non-diabetic man with benign prostatic hyperplasia and neurogenic bladder presented at our hospital with fever and lower abdominal pain. Urinalysis and urine culture revealed pyuria and bacteriuria with Citrobacter freundii. Abdominal computed tomography revealed intramural gas, which suggested the diagnosis of emphysematous cystitis. He recovered and the intramural gas appeared to have disappeared on the abdominal computed tomography after urinary drainage and antibiotic therapy. Ninty-nine cases of emphysematous cystitis have been reported in Japan including this case.

Nosocomial outbreak of serious canine infectious tracheobronchitis (kennel cough) caused by canine herpesvirus infection.

Canine herpesvirus (CHV; Canid herpesvirus 1) is principally a perinatal pathogen of pregnant bitches and newborn pups and secondarily a respiratory tract pathogen of older pups and dogs. Infectious disease of the canine respiratory tract frequently occurs among dogs in groups, in which it is called " infectious tracheobronchitis" (ITB). Mortality from ITB is generally negligible, and the clinical importance of CHV as an ITB pathogen is considered to be low. The present report describes a novel ITB outbreak accompanied by death among aged dogs in an animal medical center. Most inpatient dogs had received medications that could induce immunosuppression. CHV was the only pathogen identified, and several CHV isolates were recovered in cell culture. No other viral pathogens or significant bacterial pathogens were found. Molecular and serological analyses revealed that the causative CHV isolates were from a single source but that none was a peculiar strain when the strains were compared with previous CHV strains. The virus had presumably spread among the dogs predisposed to infection in the center. The present results serve as a warning to canine clinics that, under the specific set of circumstances described, such serious CHV outbreaks may be expected wherever canine ITB occurs.

Chronological analysis of canine parvovirus type 2 isolates in Japan.

Fifty-five canine parvovirus type 2 (CPV) samples, 12 fecal specimens and 43 cell culture isolates, were examined for their genetic characteristics of VP2 gene. They were collected from the diseased dogs at various districts of Japan during 27 years from 1980 to 2006. A fragment of VP2 gene was analyzed by restriction fragment length polymorphism assay and DNA sequencing. The original antigenic type 2 of CPV (CPV-2) was no longer found in the samples since 1984, and two antigenic variants CPV-2a and CPV-2b replaced CPV-2 as predominant types for about 5 years from 1982. A new genetic variant of prototype CPV-2a with non-synonymous substitution at the VP2 amino acid residue 297 from Ser to Ala was first detected in 1987. New CPV-2b with the same amino acid substitution at position 297 as new CPV-2a was also detected from the samples collected in 1997. Since then new CPV-2b has been the predominant CPV over the field of Japan. Several additional amino acid substitutions were detected in the VP2 gene of some recent CPV strains. Neither CPV-2c(a), CPV-2c(b), nor "Glu-426" of the antigenic variants previously found outside the country was detected in any samples tested. Reactivity of new CPV-2a and 2b variants against antibodies produced by the current vaccine products was determined by a cross hemagglutination-inhibition test. The recent field CPV isolates reacted more efficiently to the antibodies produced in dogs vaccinated with the new CPV-2b vaccine strain than the conventional CPV-2 vaccine strain.