A Case of Metastatic Urachal Cancer Including a Neuroendocrine Component Treated with Gemcitabine, Cisplatin and Paclitaxel Combination Chemotherapy

The present case report describes a case of recurrent and advanced urachal carcinoma including neuroendocrine features with iliac bone metastasis after partial cystectomy and adjuvant chemotherapy consisting of irinotecan and cisplatin in a 32-year-old man. He received gemcitabine/cisplatin/ paclitaxel (GCP) combination chemotherapy, consisting of gemcitabin (1,000mg/m2) on day 1, 8, cisplatin (70mg/m2) on day 1, and paclitaxel (80mg/m2) on day 1 and 8. After three cycles of chemotherapy, PET-CT showed complete regression of the disease. So the patient underwent total cystourethrectomy, and histological examination showed an almost complete pathological response. External beam radiation therapy was also given to the ileac bone metastasis regions. However, PET-CT taken 17 months after the external beam radiation showed multiple lung metastases. He received GCP chemotherapy again, which resulted in a complete response again after three cycles of chemotherapy. This is the first report on GCP chemotherapy used not only as a salvage chemotherapy but also as a rechallenge regimen for metastatic urachal cancer including a neuroendocrine component

Robotic Renal Autotransplantation: First Case Outside of North America

A 38-year-old woman with a 2.7-cm left ureteral stenosis requiring chronic ureteral stent exchange elected to undergo robotic renal autotransplantation. Left ureteropelvic junction obstruction (UPJO) was also suspected. Robotic donor nephrectomy contributed to the fine dissection for desmoplastic changes. The kidney was removed through a Gelport and examined on ice. UPJO was not seen. An end-to-side robotic anastomosis was created between the renal and external iliac vessels. The console time was 507 min, and the warm ischemia time was 4 min 5 sec. She became stent-free. Robotic renal autotransplantation is a new, minimally invasive approach to renal preservation

<原著>神経外膜を利用した神経再建方法 : 神経断端の大きさが異なる場合の神経修復

We report a new method of nerve Reconstruction, wrap-around neurorrhaphy, in which the funicular suture site is wrapped with the epineurium of the larger stump. The specific applications of this procedure in brachial plexus reconstruction are described and the clinical results presented. The method was applied in intercostal nerve transfer to the musculocutaneous nerve in 21 patients and in 12 patients with axillary nerve injury who underwent reconstruction with autografts using wrap-around neurorrhaphy. Rigid fixation of the neurorrhaphy site could be obtained using this method, and the clinical results were satisfactory.神経再建にあたって, その縫合方法には神経外膜縫合, 神経周膜縫合, 神経外膜・周膜縫合などがある. 実際には神経の種類・部位・状態などによって, その縫合方法を変えているのが現状である. 神経外膜を温存・利用して, 神経再建した場所を包みこむ神経再建の方法(wrap-around neurorrhaphy)を記述し, その適用と臨床結果を発表したこの神経再建方法は, 神経周膜縫合部位の緊張を防止し, 神経束の整然とした包み込み(packing), そして強固な神経連結を目的とする. 神経断端の大きさが著しく異なる時の神経縫合, あるし、は関節可動威か大きくて縫合部位に緊張が推定される時の神経縫合には, この方法(大きい方の神経外膜で縫合部位を包む方法)の良い適用がある. この方法で神経を再建し, 術後2年以上経過している臨床症例の結果をまとめた. 症例は, 肋間神経移行術(互いの神経断端の大きさが著しく異なる例として)の21症例と, 版窟神経再建術(関節可動域が大きい場所での神経再建例として)の12症例である. 神経外膜を利用して, 神経縫合した場所を包みこむ神経再建方法は, このような症例にきわめて良好な適用かある