To document the earlier discovery and increased detection of renal cell carcinoma, the authors reviewed cases of renal cell carcinoma detected at their institution during 1974-1977 and 1982-1985, with particular emphasis on renal tumors 3.0 cm or smaller. Only 5.3% (four of 75) of renal cell carcinomas found during 1974-1977 but 25.4% (31 of 122) found during 1982-1985 were 3.0 cm or smaller, an increase of almost five times. Of the small tumors in the 1982-1985 group 96.7% (30 of 31) were incidentally discovered, and 77.4% (24 of 31) were initially detected with computed tomography (CT) or ultrasound (US). In the later series 48.4% (15 of 31) of the small renal tumors were treated with partial nephrectomy. Follow-up shows no recurrences. Many more small renal tumors are being detected because of the use of CT and US. This will undoubtedly increase the cure rate of renal cell carcinoma because these tumors are being detected when they are small and do not cause symptoms. Partial nephrectomy will increasingly be used in the management of these small tumors.

Materials and MethodsSix patients were reviewed who had small angiomyolipomas (1 .2-4.0 cm) that contained tiny amounts of fat. A GE 8800 scanner was used in two patients and a GE 9800 in five; in one patient, one scan was obtained with each machine. Standard 1 0-mm-thick sections were used in all cases; four patients also were studied with 5-mm sections.In all patients, scans were obtained with IV contrast material; three patients had unenhanced scans as well. In total, 45 g of iodine were administered by the rapid bolus-infusion technique. Fatty tissue was considered to be present within a tumor if a region-of-interest value of -10 H or lower was found within the tumor. Region-of-interest measurements were used that included at least a total of three adjacent pixels. In three cases, the region-of-interest measurement included nine pixels or more. CT scanners were calibrated daily with a phantom.

Sonographic images of the vocal cords were obtained in 41 healthy human subjects using a phased array realtime ultrasound scanner. The thyroid cartilage provides the acoustic window for sonographic visualization of the vocal cords. The false vocal cords appear as hyperechoic structures, while the true vocal cords are seen as hypoechoic structures. The symmetry of movement of the vocal cords during respiration becomes apparent on examination in real time. Sonography may prove to be a potentially useful technique for the examination of the vocal cords.

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