[A Case of Renal Cell Carcinoma Choroidal Metastasis Diagnosed from Vision Disorders].

A 69-year-old male with the complaint of a cough was referred to our hospital from a clinic where he was found to have simultaneous metastases of the left kidney tumor. We performed left cytoreductive nephrectomy, and administered sunitinib after the surgery. The first line treatment was not effective. Then we changed the therapeutic agent to pazopanib as the second line treatment. Lung and lymph node metastases gradually shrunk, but he developed right vision disorders and was diagnosed with bilateral metastatic retinal tumors. First, irradiation to the right eye was performed while discontinuing pazopanib. Sudden treatment withdrawal caused his general condition to worsen temporally, but irradiation could be continued by resuming administration of pazopanib. As a consequence, the progression of the visual field disorder was suppressed by the additional ophthalmologic treatment. Renal cell carcinoma choroidal metastases are rare, but we need to consider them when the patient has vision disorders.

Outcomes of laparoscopic resection of urachal remnants followed by novel umbilicoplasty.

OBJECTIVE: The purpose of the study was to report the outcomes of our modified techniques of laparoscopic urachal resection, followed by novel umbilical-plasty using dermal regenerative grafts for symptomatic urachal remnants. METHODS: Between March 2014 and December 2016, laparoscopic urachal resection was carried out on 45 patients with complaints of urachal remnants. After extraction of the specimen and closure of the fascia at the umbilical site, a 1-cm square section of dermal regeneration sheet (TERUDERMIS®, Olympus) was suture retained between the fascia and the skin. Patient satisfaction with cosmesis was scored prospectively using the visual analogue scale (VAS). Perioperative records were reviewed to assess surgical outcomes. RESULTS: Laparoscopic urachal resection was successfully conducted via the transperitoneal approach. Postoperative bleeding was experienced in one patient (2.2%), which was subsequently controlled laparoscopically. Infection subsided with symptomatic relief in all patients. No symptomatic recurrences were encountered. Over 80% of patients (37/45) rated the cosmetic outcome of the plasty as good to excellent, with the median scores of 8 (range 5-10). CONCLUSIONS: Laparoscopic urachal resection is safe and curative with reasonable risk of complications. Novel umbilicoplasty using dermal regenerative graft is very simple technique and offers satisfactory cosmetic outcomes. Further follow-up and cosmesis evaluation are required.

Earlier use of androgen receptor-axis-targeted drugs may improve overall survival in patients with non-metastatic castration-resistant prostate cancer.

BACKGROUND: To evaluate the role of androgen receptor-axis-targeted drugs (ARAT) in non-metastatic castration-resistant prostate cancer (nmCRPC) versus mCRPC. METHODS: Chemotherapy-naive patients (n = 114) with CRPC who had no metastasis at the time of diagnosis were included in this retrospective study. All patients were treated with ARAT at Jikei University and its affiliated hospitals from July 2014 to March 2017. The patients were stratified into nmCRPC (n = 81) and mCRPC (n = 33) groups according to their metastatic status at ARAT induction. The primary outcome measure was difference in overall survival (OS) between groups from the time of CRPC diagnosis. The patients were compared for progression-free survival (PFS) and prostate-specific antigen (PSA) response. The predictors of OS were explored by a multivariate Cox model. RESULTS: The baseline demographics did not differ significantly between the groups. The median observation period from the diagnosis of CRPC was 24.5 months (range: 3-135) and 20 months (range: 1-66) in nmCRPC and mCRPC groups, respectively. The nmCRPC group demonstrated better OS from the time of diagnosis of CRPC in Kaplan-Meier analysis than mCRPC group (86 months vs 40 months; P = 0.004), with similar results obtained for PFS (P = 0.048) and PSA response (P = 0.0014). Multivariate analysis demonstrated non-metastatic status, low PSA, and long PSA doubling time (PSADT) at ARAT induction as the significant predictors of longer OS (P = 0.044, 0.0001, and 0.026, respectively). CONCLUSIONS: Early use of ARAT may improve OS, PFS, and PSA response in CRPC. Larger, prospective studies will be required to confirm our findings.

[SIGNIFICANT, TRANSIENT VISUAL DISTURBANCE AFTER LAPAROSCOPIC RADICAL PROSTATECTOMY].

Visual disturbance following non-ophthalmologic surgery under general anesthesia is rare but can be devastating both socially and medicolegally. Immediate salvage intervention as well as prevention is of utmost importance since this can be a serious blow to patient's functional outcome postoperatively. We experienced a case of temporary but significant visual disturbance right after transperitoneal laparoscopic radical prostatectomy for localized prostate cancer. We need to raise our levels of vigilance to this condition since it can be avoided and prevented with immediate therapeutic intervention and decent clinical awareness.