今回我々は限局性腎癌cT1b症例に対してのロボット支援腹腔鏡下腎部分切除術 (Robot-assisted partial nephrectomy : RAPN), 開腹腎部分切除術 (Open partial nephrectomy : OPN) の手術成績・術後腎機能を後方視的に検討した. propensity scoreによる1 : 1 matchingを行い, 患者因子および腫瘍因子の調整を行った (RAPN38例OPN38例). RAPNはOPNに対して推定出血量, 術後在院日数で有意に短縮・減少していた (p＝0.0014, p＝0.0281). また, RAPNは手術12ヶ月後でeGFR低下率が小さくなる傾向であったが, 統計学的有意差を認めなかった (p＝0.1018).

症例は51歳男性．3日前からの感冒症状に引き続いた1日前からの消化器症状と口渇にて受診し，随時血糖988 mg/dL，HbA1c 6.2 %であった．ケトアシドーシスを来しており，空腹時血中CPR及び尿中CPRが測定感度未満とインスリン自己分泌の枯渇を認め劇症1型糖尿病と診断した．抗GAD抗体（RIA）8.2 U/mL，抗IA-2抗体1.4 U/mLと重複陽性であったが，HLAクラスIIハプロタイプは自己免疫性1型糖尿病に疾患抵抗性のDRB1＊15：01-DQB1＊06：02：01を有していた．自己免疫性1型糖尿病と劇症1型糖尿病では病態が異なるため，本症例のHLAクラスIIハプロタイプの影響は慎重に考慮すべきであるが，膵島関連自己抗体重複陽性は自己免疫の関与を示している．本症例は劇症1型糖尿病における自己免疫の関与について非常に興味深い症例である．

症例は52歳男性．27歳時に原田病でステロイド治療を行った．今回2015年1月中旬，食欲低下，腹痛，意識障害で救急外来を受診．受診時pH 7.021，尿ケトン2＋，血糖1111 mg/dL，HbA1c 6.3 %で糖尿病性ケトアシドーシスを認め，十分な補液とインスリン持続静注を開始した．膵外分泌酵素は上昇，後日判明した膵島関連自己抗体は陰性，また内因性インスリン分泌は枯渇しており劇症1型糖尿病と診断した．本症例は原田病と劇症1型糖尿病の共通の疾患感受性であるHLAのハプロタイプであるHLA DRB1*04:05-DQB1*04:01を有し，入院後はエンテロウイルス（コクサッキーB1）抗体価が上昇していた．本症例は原田病既往から25年経過して，今回エンテロウイルスに感染し劇症1型糖尿病を発症したと考えられた．

症例は83歳，男性．高血圧，狭心症で通院中，メキシレチン塩酸塩を内服6週後より掻痒を伴う皮疹が出現，同薬を中止後も増悪し全身性紅斑となり1週後に入院となる．入院翌日から口渇，多飲，多尿が出現し，入院第3病日の検査で血糖1069 mg/dL，HbA1c 6.1 ％，著明な血中ケトン体の増加，インスリン分泌能の枯渇等から薬剤性過敏症症候群（DIHS）に伴って発症した劇症1型糖尿病（FT1D）の診断に至る．経過を通してヒトヘルペスウイルス（HHV）-6抗体陰性，早期から血中サイトメガロウイルス（CMV）-DNAを検出しCMV IgG抗体が高値であり，複数の膵島関連自己抗体が弱陽性であった．HLAクラスIIハプロタイプではDRB1＊09：01-DQB1＊03：03を認めた．本症例の病態にCMVが関与したと考えられ，DIHSにFT1Dを合併した場合はCMVの再活性化についても考慮すべきと考えられた．

　Aggressive angiomyxoma (AAM) is a benign mesenchymal neoplasm arising in the pelvis, perineum, and vaginal wall of premenopausal women. Its recurrence rate reaches approximately 50%, and it is treated with combined surgical resection and gonadotropin-releasing hormone (GnRH) agonists. Laparoscopic surgery is superior to laparotomy in terms of accessibility and a detailed and magnified view of the surgical field. Learning the anatomy of the less familiar Retzius space may be useful for gynecologists.

　A 46-year-old G2P2 presented with an incidental finding of a pelvic mass on computed tomography. Magnetic resonance imaging revealed a 3.5-cm spindle-shaped mass between the left pubic bone and the bladder with clear demarcations from the vagina and bladder. Preoperative diagnosis suggested AAM located in the Retzius space. Because resection using a single approach from the perineal region was considered difficult, we performed laparoscopic resection with visualization of the Retzius space from the abdominal cavity, which revealed a pedunculated mass arising from the left internal obturator muscle. Because of unclear borders, we dissected the mass while observing the inside of the bladder with a cystoscope. The mass was resected, placed in a retrieval bag, and retrieved from the umbilicus. The final pathological diagnosis was AAM and prophylactic GnRH agonists were administered. No regrowth occurred in 2 years and 4 months postoperatively.

　The Retzius space between the pubic bone and bladder, also known as the retropubic space or prevesical space, is often visualized during urological surgeries. During laparotomy, the pubic bone blocks the Retzius space. Contrastingly, laparoscopy allows less invasive and safer resection of AAM arising from the left internal obturator muscle. Laparoscopic surgery for benign tumors in the Retzius space may be a feasible option as minimally invasive procedure.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease (COVID-19), which was declared a pandemic in March 2020, has since caused a serious global health crisis. COVID-19 has spread to more than 200 countries and millions have fallen ill. Patients who have undergone an organ transplant are at increased risk of complications from COVID-19 due to conditions such as hypertension, diabetes, cardiovascular disease, chronic lung disease, and obesity, as well as chronic immunosuppression. We measured antibodies to the five SARS-CoV-2 proteins in kidney transplant patients who received two approved and available BNT162B2 (mRNA) vaccinations. It is possible to simultaneously identify antibody reactions to the extracellular domain (ECD), the three individual domains of the spike protein (S1, S2, and the receptor-binding domain (RBD)), and the five proteins of the nucleocapsid. The serological response following BNT162B2 COVID-19 mRNA vaccination was investigated using possible receptors. The subjects were 111 patients one month after receiving two coronavirus vaccines following kidney transplantation. Antibodies were found in 41% (46 cases). The positive rate of antibody formation tended to be low in transplant patients, whereas in the control group of healthy subjects it was 100%. The positive rate indicated by immunosuppressant was 36% (37/100) in the cases using tacrolimus at the time of vaccination and 90% (9/10) in the cases using cyclosporine. The intensity of each fragment in antibody-positive cases showed the normalized mean fluorescence intensity (nMFI), which indicated the highest ECD levels in the transplant patients and healthy control groups, followed by RBD, S1, and S2. In the reactivity pattern of the fragments of the positive cases, the control group had an nMFI of 110,000 to 140,000, while the transplant patients had an nMFI of 6,900 to 25,000, showing a difference in cumulative nMFI. The proportion of fragments also varied greatly among transplant patients, and no uniformity was observed. By contrast, in the healthy control group, the nMFI value tended to be constant for each fragment. The results suggest that performing antibody monitoring during the Coronavirus crisis may be useful for the protection against and treatment of infection as well as in determining the individual vaccination interval, vaccination amount, and number of vaccinations required.