Adrenal metastasis of renal cell carcinoma usually is an autopsy finding and seldom a clinical diagnosis. The incidence of ipsilateral suprarenal gland involvement also can be identified by histological examination of the organ with radical nephrectomy. The necessity of adrenalectomy performed in combination with nephrectomy is discussed. After a retrospective examination of our patients we discovered 8 adrenal metastases among 138 radical nephrectomies. Five patients who also had metastases in the lymph nodes (stages pN1 to pN2) died after an average of 26.4 months. Three patients without lymph node involvement are free of tumor. In these cases routine adrenalectomy must be regarded as a possible curative treatment.

There should be an attempt to salvage the transplant after allograft rupture in all cases. Using these transplant-preserving techniques, renal function could be achieved for all patients with allograft rupture.

The prevalence of increased serum immunoreactive erythropoietin (Epo) was determined in a prospective study of 49 patients with renal cell carcinoma. Measured by a monoclonal antibody based commercial enzyme-linked immunoassay, the Epo concentration was above the normal range, determined in nonanemic humans, in four of the renal carcinoma patients. Since three of these were anemic, their increased Epo level was considered to be appropriate. The high estimate of serum Epo (218 U/l) in the fourth patient, who was not anemic, was not confirmed when tested by radioimmunoassay. Thus, in contrast with earlier studies, our results indicate that increased Epo is not a clear serological renal cell carcinoma marker. In addition, when monolayer cell cultures of 14 different established human renal carcinoma lines were screened, none of these released immunoreactive Epo in measurable amounts.

The laparoscopic technique is an efficient, minimally invasive operation with optimal results. After a brief period of training the operation can be performed in 15-30 min and is therefore no longer than embolization techniques. Treatment of both sides in one session was not a problem.

Immunosuppressed recipients of organ transplants have a higher incidence of carcinoma than the general population. A retrospective analysis was made at the Department of Urology of Bonn University, investigating 236 renal allograft recipients as to the incidence of neoplasms before and after transplantation. Eleven patients developed malignant tumours after transplantation. In 4 out of these 11 patients, case history showed pre-existing malignancies. Two of the 4 patients developed a second tumour, while the other two had tumour progression (latency period 21-77 months). Three of the 4 patients died of their tumours 21, 42 and 77 months after transplantation, whereas one female patient is still alive and free of neoplasms 32 months after transplantation. In 7 out of these 11 patients de novo tumours were diagnosed (latency period 3-88 months). All of them are still alive (NED between 15 and 85 months), six of them with good transplant function. There was no difference to be seen in the incidence of malignancies between kidneys supplied by Eurotransplant (n = 40) and ABO compatible kidneys from our own donors (n = 196). The higher incidence rate of neoplasms in transplant recipients requires high standards in preventive measures. Any suspicious change that may occur in the course of a thorough follow-up of transplant recipients must be removed and examined histologically. Patients with previous malignant diseases must be payed special attention, since they frequently tend to develop another malignant tumour and progression of existing tumours, respectively. As far as immunosuppression is concerned, therapeutic guidelines for the treatment of transplant recipients do not differ from those set up for patients on haemodialysis. Since immunosuppression with increased rates of tumour incidence can also be observed in dialysis patients, the mere fact of increased incidence of neoplasms cannot be taken as an argument against transplantation. With a more or less equal risk of tumour incidence the crucial factor should be the higher quality of life for transplant recipients.

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Colonic stenosis following resection and end-to-end-anastomosis of the colon is observed in 2-5% of all patients. The authors report that a patient with repeated episodes of colonic stenosis after resection of the sigmoid was successfully treated with an Eder-Puestow dilatator by means of a flexible endoscope.

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