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Chemotherapy of adenocarcinoma of the kidney
Chemotherapy of Adenocarcinoma of the Kidney, R. W. Talley (32: 1062, 1973)-This study reviews the experience with chemotherapeutic agents for renal tumors in 117 patients during a ten-year period on the Oncology Service at the Henry Ford Hospital. On the basis of this personal experience as well as the extensive review of the literature, the author fails to find either a single agent or a combination of agents which produces consistent response rates. A variety of alkylating antimetabolites and cancerocidal antibiotics and hormonal agents were evaluated. The author does note that the clear-cell type of adenocarcinoma of the kidney is usually more indolent than the granular-cell variety and recommends that future studies carefully delineate the different cell types being evaluated.
instances. According to the authors, metastases from testicular tumors on the right side were to the ipsilatera1 nodes in 85 per cent of cases, to both ipsilateral and contralateral nodes in 13 per cent of cases, and to contralateral nodes in only 1.6 per cent of cases. With tumors on the left side, ipsilateral nodes only were involved in 80 per cent and both ipsilateral and contralateral nodes in 20 per cent. Contralateral metastases in the absence of ipsilateral metastases were rare. None was observed with a tumor on the left side and only one with a tumor on the right. On the basis of the analysis, modified bilateral dissections are recommended for testicular tumors.
JOURNAL
OF TRAUMA
by S. H. Levey, M.D. Hormone-Induced and Spontaneous Regression Nonpenetrating Renal Vascular Injuries, T. S. of Metastatic Renal Cancer, H. J. G. Bloom (32: 1066, Morse, and B. H. Harris (13: 497, 1973)-This article 1973)--A decade of interest in the concept ofhormonal deals with the approach to and management of chilinfluence in the development and progress of experidren with blunt abdominal injuries who may have an mental and human kidney tumors is presented by the associated renal vascular injury. The authors point out author whose preliminary report stimulated clinical that the main objective is to try to identify those chilinterest in this concept. According to the author, hor, dren who will require surgery. Preliminary work in the monal treatment of metastatic renal cancer is responsible for imnrovement rather than anv coincidental d authors’ laboratory suggest that the time between vascular occlusion and irreparable destruction of the kidnatural event, although the response is usually incomney may be considerably longer than previously beplete or of limited duration. lieved. The authors reiterate the facts that there are no clinical pathognomonic features of renal vascular occlusion in blunt trauma and that hematuria may or may Distribution of Retroperitoneal Lymph Node not be present. They emphasize the fact that “every Metastases in Testicular Germinal Tumors, B. Ray, child with any red cells at all in the urine after a nonS. I. Hajdu, and W. F. Whitmore, Jr. (33: 340, penetrating injury” should be evaluated for possible 1974)-The distribution of retroperitoneal lymph renal injury. They recommend that the first step be an node metastases in 283 patients with testicular germiinfusion pyelogram performed as soon after injury as nal tumors is presented. A topographic identification the stabilized patient can be moved. If this is diagnosof the retroperitoneal nodes relative to the great vestic, no further studies are needed; however, ifvisualisels is utilized and the distribution of nodal metastases zation is present bilaterally but is not of a diagnostic defined and reported. In the earlier part ofthe study, a quality, the infusion pyelogram is repeated in fortysystematic bilateral retroperitoneal lymph node diseight hours. If the first pyelogram shows no visualizasection was usually performed. All apparent lymphatic tion on the suspected injured side, a renal scan is and perivascular tissues were removed from the laterobtained at once. The authors, in a previously reported al, anterior, posterior, and medial aspects of the major study, showed that scanning was as accurate as arvessels extending from the renal pedicles superiorly to teriography with a significantly less rate of morbidity. the external iliac vessels bilaterally. The evidence from It is believed that if children are studied in this mansuch extended dissection suggested that modified bilateral dissection would encompass the sites of retner, vascular injuries can be identified in time to salvage kidneys which otherwise would be lost. roperitoneal lymph node metastases in a majority of I
362
,
UROLOGY
/ SEPTEMBER
1974
/ VOLUME
IV, NUMBER
3
instances. According to the authors, metastases from testicular tumors on the right side were to the ipsilatera1 nodes in 85 per cent of cases, to both ipsilateral and contralateral nodes in 13 per cent of cases, and to contralateral nodes in only 1.6 per cent of cases. With tumors on the left side, ipsilateral nodes only were involved in 80 per cent and both ipsilateral and contralateral nodes in 20 per cent. Contralateral metastases in the absence of ipsilateral metastases were rare. None was observed with a tumor on the left side and only one with a tumor on the right. On the basis of the analysis, modified bilateral dissections are recommended for testicular tumors.
JOURNAL
OF TRAUMA
by S. H. Levey, M.D. Hormone-Induced and Spontaneous Regression Nonpenetrating Renal Vascular Injuries, T. S. of Metastatic Renal Cancer, H. J. G. Bloom (32: 1066, Morse, and B. H. Harris (13: 497, 1973)-This article 1973)--A decade of interest in the concept ofhormonal deals with the approach to and management of chilinfluence in the development and progress of experidren with blunt abdominal injuries who may have an mental and human kidney tumors is presented by the associated renal vascular injury. The authors point out author whose preliminary report stimulated clinical that the main objective is to try to identify those chilinterest in this concept. According to the author, hor, dren who will require surgery. Preliminary work in the monal treatment of metastatic renal cancer is responsible for imnrovement rather than anv coincidental d authors’ laboratory suggest that the time between vascular occlusion and irreparable destruction of the kidnatural event, although the response is usually incomney may be considerably longer than previously beplete or of limited duration. lieved. The authors reiterate the facts that there are no clinical pathognomonic features of renal vascular occlusion in blunt trauma and that hematuria may or may Distribution of Retroperitoneal Lymph Node not be present. They emphasize the fact that “every Metastases in Testicular Germinal Tumors, B. Ray, child with any red cells at all in the urine after a nonS. I. Hajdu, and W. F. Whitmore, Jr. (33: 340, penetrating injury” should be evaluated for possible 1974)-The distribution of retroperitoneal lymph renal injury. They recommend that the first step be an node metastases in 283 patients with testicular germiinfusion pyelogram performed as soon after injury as nal tumors is presented. A topographic identification the stabilized patient can be moved. If this is diagnosof the retroperitoneal nodes relative to the great vestic, no further studies are needed; however, ifvisualisels is utilized and the distribution of nodal metastases zation is present bilaterally but is not of a diagnostic defined and reported. In the earlier part ofthe study, a quality, the infusion pyelogram is repeated in fortysystematic bilateral retroperitoneal lymph node diseight hours. If the first pyelogram shows no visualizasection was usually performed. All apparent lymphatic tion on the suspected injured side, a renal scan is and perivascular tissues were removed from the laterobtained at once. The authors, in a previously reported al, anterior, posterior, and medial aspects of the major study, showed that scanning was as accurate as arvessels extending from the renal pedicles superiorly to teriography with a significantly less rate of morbidity. the external iliac vessels bilaterally. The evidence from It is believed that if children are studied in this mansuch extended dissection suggested that modified bilateral dissection would encompass the sites of retner, vascular injuries can be identified in time to salvage kidneys which otherwise would be lost. roperitoneal lymph node metastases in a majority of I
362
,
UROLOGY
/ SEPTEMBER
1974
/ VOLUME
IV, NUMBER
3