In urology, molecular-targeted therapies have been mainly used to treat advanced renal cell carcinoma (RCC). While the treatment for RCC is surgical resection, drug treatments can also be considered in cases of incurable or metastatic advanced RCC. Since the 1980s, cytokine therapy, such as the injection of interferon-α and interleukin-2, has been the main therapy for advanced RCCs. Individuals with RCC frequently overexpress vascular endothelial growth factor (VEGF), which is characterized by increased blood flow and angiogenesis. Because of the molecular characteristics of RCC, drug treatments targeting these molecules or their corresponding downstream signaling molecules have been researched and developed. In Japan, five types of multi-kinase inhibitors, including receptor tyrosine kinases and two types of mammalian target of rapamycin (mTOR) inhibitors, are currently being used.

Although these molecular-targeted therapies have more significant therapeutic effects than cytokine therapies, they have problems with adverse effects and drug resistance. Immune checkpoint inhibitors (ICI) related to the immune system in cancer pathogenesis were developed several years ago, and insurance coverage has been applied for advanced RCC in Japan since 2016. The usefulness of ICI combination therapies has been demonstrated in several clinical trials, and four types of ICI combination therapies have been approved as the first-line treatment for advanced RCC in Japan. Based on various guidelines, it is important to consider patient, tumor, and drug characteristics when selecting the appropriate drug treatment for advanced RCC.

Diagnostic criteria of gestational diabetes mellitus (GDM) revised in 2010 by the International Association of Diabetes and Pregnancy Groups are widely accepted in Japan. Not only did the threshold values for the diagnosis of GDM change, but overt diabetes in pregnancy (ODP) was differentiated from GDM. We conducted a retrospective questionnaire study among Saiseikai Hospitals in 2015, regarding whether the clinical management of diabetes in pregnancy at Saiseikai Hospitals changed after the revision of GDM criteria. As for GDM, the rate of hospitals dealing with deliveries numbering more than 11 patients per year before and after the revision of GDM criteria changed from 9 to 36%, diagnosing most frequently in the first trimester changed from 10 to 30%, and implementation of self-monitoring of blood glucose at the initial visit changed from 0 to 36%. For pregestational diabetes and ODP, the rate of hospitals achieving appropriate pregestational glycemic control changed from 29 to 57%. Although the results were not significant, we provided an opportunity for physicians to advance their understanding of diabetes in pregnancy, requiring the confirmation of criteria. In this review, some issues about diabetes in pregnancy are discussed.

A 77-year-old man presented to our emergency department with acute back pain. His whole-body computed tomography showed a massive anterior mediastinal hematoma with a right-side shift of the trachea and esophagus, pericardial fluid collection without extravasation of contrast, and no false lumen enhancement. An emergent surgery was planned to prevent the blow-out rupture of the aorta and detect the anterior mediastinal bleeding site. The patient was cooled to below 26°C; selective cerebral perfusion was established under circulatory arrest. After the hematoma around the left subclavian artery was removed, we found a rare proximal left subclavian artery rupture. The vessel was ligated proximally and distally, and the aortic arch was transected between the left carotid artery and left subclavian artery, followed by frozen elephant trunk implantation and distal anastomosis of the four-branched graft. The postoperative course of the patient was uneventful, and he was discharged from our hospital in a stable condition.

A reconstructed gastric-role tracheal fistula (RGTF), an unusual complication after esophagectomy, is characteristic in posterior mediastinal route gastric tube reconstruction. In spite of occurring rarely, RGTF gives various symptoms, leading to a decrease in the patient's quality of life (QOL), which is often fatal. Therefore, early detection and appropriate treatment are required to improve the patient's QOL.

Although curative treatment for RGTF is surgery, in a poor general condition, conservative treatments such as airway stenting should be considered.

This case report shows a successful case where tracheal stenting was performed for an RGTF after esophagectomy for esophageal cancer. A man in his 70s who underwent thoracoscopic esophagectomy and posterior medial route gastric tube reconstruction at 1 month before. Since the patient's general condition was poor, and surgical treatment was difficult, he was referred to our hospital for undergoing tracheal stent surgery for curing the RGTF. A silicon stent was placed by a rigid bronchoscope under general anesthesia. Air leak from the gastric tube disappeared immediately after the tracheal stent was placed, and the general condition also improved.