Two patients with glossopharyngeal neuralgia associated with cardiac syncope were treated with temporary cardiac pacemakers for cardiac syncope and then microvascular decompression. The offending arteries were the posterior inferior cerebellar artery in one patient and the anterior inferior cerebellar artery in the other. The offending arteries were attached to the glossopharyngeal nerve and the vagal nerve at the root entry zones. After surgery, the patients were free from neuralgia and cardiac syncope did not occur after the pacemakers were extracted. Implantation of a temporary cardiac pacemaker in the perioperative period ensures safe microvascular decompression.

Abbreviations & AcronymsObjectives: To evaluate the utility of diameter-axis-polar nephrometry score to evaluate partial nephrectomy outcomes. Methods: Renal tumors of 127 patients with a functional contralateral kidney who underwent partial nephrectomy were scored using the diameter-axis-polar and R.E.N.A.L nephrometry scores. The mean tumor diameter was 2.9 cm (range 1.0-8.0 cm) and warm ischemic time was 27.3 min (range 12-46 min). All patients underwent 99m Tc-mercaptoacetyltriglycine renal scintigraphy preoperatively and 6 months postoperatively to assess effective renal plasma flow. We compared nephrometry scores with estimated glomerular filtration rate, effective renal plasma flow and ischemic time. ). Univariate and multivariate analyses showed that diameter-axis-polar score had a stronger association with the percent change in estimated glomerular filtration rate, effective renal plasma flow in the treated kidney and ischemia time compared with the R.E.N.A.L score. Conclusions: Diameter-axis-polar nephrometry score is a useful tool for the assessment of small renal tumors amenable to partial nephrectomy, and it better predicts postoperative functional changes and ischemic time compared with the R.E.N.A.L nephrometry score.

To study bowel function in urothelial cancer patients treated with pembrolizumab and to assess its association with treatment efficacy. Methods: This retrospective study was analyzed for patients with metastatic urothelial cancer who received immune checkpoint inhibitor treatment between December 2017 and June 2019 at Nagoya University and affiliated hospitals in Japan. The association between bowel dysfunction (defined as constipation or need for laxatives) and treatment efficacy was investigated. Results: We retrospectively enrolled 73 patients with metastatic urothelial cancer who received immune checkpoint inhibitor treatment. All patients received pembrolizumab at 200 mg per bodyweight administered intravenously every 3 weeks. Performance status was 0-1 in 58 patients (79.5%), and liver metastasis was detected in 22 patients (30.1%). The median age was 72 years (range 40-89 years). A total of 45 patients had constipation. The median progression-free survival and overall survival from the start of immune checkpoint inhibitor treatment was 4.0 months (95% confidence interval 1.0-17.3) and 6.6 months (95% confidence interval 1.0-18.0), respectively. Patients with constipation had a significantly higher risk of disease progression (P = 0.005). There was no significant association between constipation and overall survival (P = 0.131). However, complete response was observed among two patients treated with immune checkpoint inhibitor, both of whom did not present constipation. Conclusion: The presence of constipation might be a prognostic factor for urothelial cancer patients undergoing immune checkpoint inhibitor treatment.

Objective: To determine pulmonary functional changes that predict early clinical outcomes in valve surgery requiring long cardiopulmonary bypass (CPB). Methods: This retrospective study included 225 consecutive non-emergency valve surgeries with fast-track cardiac anesthesia between January 2014 and March 2020. Blood gas analyses before and 0, 2, 4, 8, and 14 h after CPB were investigated. Results: Median age and EuroSCORE II were 71.0 years (25–75 percentile: 59.5–77.0) and 2.46 (1.44–5.01). Patients underwent 96 aortic, 106 mitral, and 23 combined valve surgeries. The median CPB time was 151 min (122–193). PaO2/FiO2 and AaDO2/PaO2 significantly deteriorated two hours, but not immediately, after CPB (both p < 0.0001). Decreased PaO2/FiO2 and AaDO2/PaO2 were correlated with ventilation time (r2 = 0.318 and 0.435) and intensive care unit (ICU) (r2 = 0.172 and 0.267) and hospital stays (r2 = 0.164 and 0.209). Early and delayed extubations (<6 and >24 h) were predicted by PaO2/FiO2 (377.2 and 213.1) and AaDO2/PaO2 (0.683 and 1.680), measured two hours after CPB with acceptable sensitivity and specificity (0.700–0.911 and 0.677–0.859). Conclusions: PaO2/FiO2 and AaDO2/PaO2 two hours after CPB were correlated with ventilation time and lengths of ICU and hospital stays. These parameters suitably predicted early and delayed extubations.

The authors present the first case report of pre-surgical axitinib treatment on primary renal tumor and vena cava thrombus. We report the case of a 78-year-old woman with renal cell carcinoma and inferior vena cava tumor thrombus, successfully downstaged with pre-surgical therapy with axitinib. A significant objective response was observed for tumor size and thrombus. After initiation of axitinib therapy, computed tomography showed a decrease, from 57 to 51 mm, in the maximal renal tumor diameter. The tumor thrombus had shortened to 42 mm and had moved to the inferior hepatic vein (Levels 4-3), thereby obviating the need for thoracotomy. The patient finally accepted surgical treatment. Our case was enabled to perform less surgery for advanced renal cell carcinoma with tumor thrombus using axitinib as a pre-surgical therapy.Key words: renal cell carcinoma -pre-surgical -molecular target agents -axitinib -IVC thrombus CASE REPORTThe use of targeted agents in pre-surgical/neoadjuvant therapy for advanced renal cell carcinoma (RCC) was considered to be of particular merit in both preserving renal function and reducing the risk of invasive surgery. However, an advantage in improving overall survival (OS) and progression-free survival (PFS) has not yet been established. Many clinical trials addressing this issue are now ongoing. Cases of pre-surgical and neoadjuvant therapy for advanced RCC using sorafenib, sunitinib and temsirolimus have been reported (1 -4). However, reports of axitinib neoadjuvant and pre-surgical therapy for advanced RCC complicated with inferior vena cava (IVC) tumor thrombus are rare. The vascular endothelial growth factor receptor (VEGFR) inhibitor axitinib is considered to be a drug with a high cytoreductive effect. In the pivotal Phase III AXIS trial(5), administration of axitinib in the second-line setting for advanced RCC led to a partial response (PR) rate of 19.6%, a significant improvement over that of sorafenib (9.2%) (P , 0.001). In a Japanese trial for patients with cytokine treatment-resistant RCC, axitinib resulted in a PR rate of 57.8% (6). Therefore, axitinib seems to be an effective cytoreductive drug for advanced RCC patients and may be of benefit in treating patients with IVC tumor thrombus in the neoadjuvant/pre-surgical setting.Here, we report the case of a 78-year-old woman with RCC and IVC tumor thrombus, successfully downstaged with presurgical therapy with axitinib, thereby facilitating radical surgery for the RCC and obviating the need for thoracotomy.A previously healthy 78-year-old woman presented with gross hematuria and European Cooperative Oncology Group performance status 0. Whereas the physical examination findings were unremarkable, abdominopelvic computed tomography (CT) revealed a 57 mm right renal mass with central necrosis. The IVC contained a tumor thrombus (Level 4 in Mayo Clinic classification) located above the diaphragm and below the right atrium (Fig. 1). It did not occupy the entire circumference of the IVC. There were no radiographically visible noda...