Comprehensive Investigations of Multiple Factors That Are Related to Refractory Outcome in Urosepsis Patients

Background: Urosepsis is an acute life-threating disease, and some cases show refractory outcome to therapy. In an aging society of developed countries, characteristics of urosepsis are becoming complicated. We performed a comprehensive investigation regarding the clinical and social aspects that are related to refractory outcomes in urosepsis patients. Methods: The patient cohort consisted of 66 patients with urosepsis. Multiple factors from clinical and social aspects were reviewed retrospectively. Two categories of refractory outcomes were defined. One was afebrile resistance (AR); fever continued more than 7 days from the initiation of therapy. Another was discharge resistance (DR); hospitalization continued for more than 30 days. Logistic regression analyses were performed to identify significant factors that are related to the AR or DR. Results: Univariate analysis demonstrated that high score of Eastern Cooperative Oncology Group Performance Status (ECOG PS) (? 2) and Age-adjusted Charlson comorbidity index (CCI) (? 4), high serum C-reactive protein (CRP) level (? 14.9 mg/dL), and low serum albumin level (? 2.26 g/dL) were significantly related to AR. Univariate analysis results also revealed that high score of ECOG PS (? 2), high serum creatinine level (? 1.54 mg/dL) and vasopressor administration were significantly related to DR. Multivariate analyses demonstrated that low serum albumin level (? 2.26g/dL) was the only significant factor that was related to AR. In contrast, high score of ECOG PS (? 2) and high serum creatinine level (? 1.54 mg/dL) were significant factors that were related to DR. Conclusion: It is suggested that evaluating serum albumin levels is essential for the therapeutic first step because hypoalbuminemia was the significant factor that was related to obstruction to antipyresis. It is also suggested that the deterioration of patients’ activities of daily living and renal dysfunction might be the refractory factors for discharge from the hospital, which was the ultimate therapeutic goal

Retroperitoneal Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma: A Report on 2 Initial Cases

We report our experience with retroperitoneal laparoscopic radical nephrectomy in 2 patients with renal cell carcinoma. In this procedure, a working space in the retroperitoneum is created using the blunt balloon dissection technique. Carbon dioxide insufflation is performed, and 4 trocars are inserted into the retroperitoneal cavity through the lateral abdominal wall. The kidney is removed together with the perirenal fat and Gerota's fascia in a muscle-splitting fashion. Using this procedure, a right nephrectomy was performed in a 65-year-old man with a 2.4-cm tumor and in a 54-year-old woman with a 3.5-cm tumor. Operative time was 220 min and 195 min, respectively, and estimated blood loss was 10 mL and 115 mL, respectively. There were no major perioperative complications. Although a long-term follow-up is necessary to evaluate the efficacy of this procedure, it will probably become a standard treatment modality for localized renal cell carcinoma