What's known on the subject? and What does the study add?• The increased detection of small renal masses (SRMs) with diagnostic imaging has highlighted the importance of preserving renal function, with many patients with SRMs being managed with nephron-sparing procedures. The significance of positive surgical margins (PSMs) is debatable and various studies have looked at the risk factors for PSMs and recurrence. It has been suggested that tumour size may be a risk factor and the centrality of the tumour has been found to be an increased risk factor. The indication and location of the tumour has been found to be an independent predictive factor for recurrence.• Various studies have assessed the outcome of patients with PSMs with short-to intermediate-term follow-up. Our study has an intermediate-term median follow-up of 7.9 years, and found no significant difference in 5-year disease-specific and overall survival rates between patients with PSMs and negative surgical margins. We also found that tumour size was not significant, but pathological stage and fat invasion were found to be significant. These risk factors have not been published in previous studies. Objectives• To determine the prevalence of positive surgical margins (PSMs) on a population level.• To identify the predictors of PSMs and assess their impact on survival. Patients and Methods• Using the Ontario Cancer Registry, we reviewed pathology reports on 664 patients after partial nephrectomy for renal cell carcinoma between 1995 and 2004.• Demographic information and pathological characteristics were obtained and multivariable logistic regression analysis was performed to determine the predictors of PSMs.• Kaplan-Meier analysis was used to examine disease-specific (DSS) and overall survival (OS) by margin status. A multivariable Cox proportional hazards model was used to determine the independent association between PSMs and survival. Results• The mean patient age was 57.7 years and 61.6% were men. Tumour size was <2.0 cm in 25%, 2.0-3.9 cm in 59%, 4.0-6.9 cm in 13%, and Ն7.0 cm in 3% of patients.• Seventy-one patients (10.7%) had PSMs on final pathology. Only stage (P = 0.02) and fat invasion (P = 0.04) were significantly associated with PSMs.• At a median follow-up of 7.9 years, the unadjusted 5-year DSS and OS rates were 91.8 and 88.3%, respectively. • Survival rates did not differ by surgical margin status, with 90.9 and 84.4% 5-year DSS and OS rates for patients with PSMs compared with 91.9 and 88.6% for those with a negative surgical margin (P = 0.58, log rank test).• Using a Cox proportional hazards model, surgical margin status was not associated with time to all-cause death (P = 0.67). Conclusion• Our population-level data suggest that, although PSMs are fairly prevalent, they appear to have little to no impact on 5-year survival rates.Keywords nephron-sparing surgery, positive surgical margin, partial nephrectomy, renal cell carcinoma E300 © 2013 BJU International | 111, E300-E305 |

OBJECTIVE -We have tested whether the Pro12Ala variant of the peroxisome proliferatoractivated receptor (PPAR)-␥ nuclear receptor involved in thiazolidinedione (TZD) action accounted for the failure of troglitazone to increase insulin sensitivity in nondiabetic Hispanic women with previous gestational diabetes treated in the Troglitazone in Prevention of Diabetes (TRIPOD) study.RESEARCH DESIGN AND METHODS -Ninety-three women assigned to troglitazone had intravenous glucose tolerance tests at randomization and after 3 months of treatment with troglitazone, 400 mg/day, and were genotyped for the Pro12Ala variant of the PPAR-␥ gene. Subjects were divided into tertiles based on their change in minimal model insulin sensitivity (S i ) during the first 3 months of troglitazone treatment.RESULTS -The mean changes in S i in the bottom, middle, and top tertiles of S i response were Ϫ0.21 Ϯ 0.57, 0.91 Ϯ 0.26, and 2.58 Ϯ 1.32 min Ϫ1 per U/ml ⅐ 10 Ϫ4 , respectively. Frequencies of the Ala/Ϫ genotype were 30, 22, and 26% in the same three tertiles (P ϭ 0.77). Analysis of phenotypes by genotype revealed only small differences between the Pro/Pro and Ala/Ϫ groups, respectively, in baseline S i (2.76 Ϯ 0.19 vs. 2.33 Ϯ 0.33 ϫ 10 Ϫ4 min Ϫ1 per U/ml; P ϭ 0.27), the change in S i after 3 months of troglitazone treatment (1.19 Ϯ 0.17 vs. 0.93 Ϯ 0.30; P ϭ 0.46), and the cumulative incidence of diabetes during a median follow-up of 30 months (13 vs. 17%; P ϭ 0.66).CONCLUSIONS -Among young Hispanic women at high risk for type 2 diabetes, the Pro12Ala variant of the PPAR-␥ receptor gene did not explain the failure of ϳ1/3 of subjects to increase their insulin sensitivity when placed on troglitazone at a dose of 400 mg/day.

Malignant ascites from advanced prostate cancer is rare and has a poor prognosis. We report a case of a 57-year-old African American male presenting with weight loss, lower urinary tract symptoms and voiding dysfunction. He also had renal failure with metabolic abnormalities associated with significant abdominal distention and pain. Computed tomography showed ascites, which was pathologically confirmed by immunostaining and cytological identification of malignant cells. Prostate biopsy identified high-grade prostate cancer which responded to hormonal therapy with a significant decrease in serum prostatic-specific antigen. Ascites was managed with paracentesis and renal failure with hemodialysis as needed.