Purpose:Radical treatment in elderly patients with renal tumor remains debatable due to uncertainties regarding the risk of surgical complications, risk of end-stage renal disease (ESRD) and survival benefit. The aim of the study was to assess outcomes of radical treatment for renal cancer in elderly patients.Materials and Methods:This retrospective analysis enrolled 507 consecutive patients treated with partial or radical nephrectomy due to renal mass. Patients with upfront metastatic disease (n=46) and patients lost to follow-up (n=110) were excluded from the analysis. Surgical, functional (screen for ESRD development) and survival outcomes were analyzed in patients aged >75 years in comparison to younger individuals.Results:The analyzed group included 55 elderly patients and 296 younger controls. Within the cohort a total of 148 and 203 patients underwent radical and partial nephrectomies respectively. The rate of surgical complications, including grade ≥3 Clavien- Dindo complications, did not differ between groups (3.6% vs. 4.4%, p=0.63). Median length of hospital stay was equal in both groups (7 days). During a follow-up (median 51.9 months, no difference between groups), ESRD occurred in 3.4% of controls and was not reported in elderly group (p=0.37). Younger patients demonstrated a statistically significant advantage in both overall survival and cancer-specific survival over elderly patients (OS 94.6% vs. 87% p=0.036, CSS 97.3% vs. 89.1% p=0.0008).Conclusions:Surgical treatment in elderly patients with renal tumor is as safe as in younger individuals and does not increase the risk of ESRD. However, cancer specific survival among these patients remains shorter than in younger patients.

IntroductionStandard intra-urethral instillation of anaesthetic gel may not sufficiently exclude pain perception during cystoscopy.AimTo evaluate the impact of the anaesthesia within the posterior urethra on pain intensity related to cystoscopy in men.Material and methodsOne hundred and twenty-seven men undergoing cystoscopy were prospectively enrolled in the study. Patients were randomly assigned to the experimental or control group (66 vs. 61 patients). Intra-urethral instillation of 2% lidocaine gel was done in both groups. In the experimental group, the posterior urethra was additionally anaesthetized with distribution of the lidocaine gel by catheterisation. The study endpoints were pain intensity at successive time points of the procedure assessed on a numeric rating scale, overall pain intensity assessed on a Likert scale, the need for analgesics during 6 h after the procedure, and the frequency of urinary tract infections (UTIs) during 14 days after the procedure.ResultsPain perception during cystoscopy did not differ significantly between the two groups (p > 0.05). However, after 6 h patients in the experimental group were more likely to declare that the cystoscopy was painless (81.8% vs. 70.2%, relative risk = 1.17). The need for analgesics and the incidence of UTI were similar in both groups (p > 0.05). Statistically significant differences regarding pain perception were observed depending on patients’ age and the number of transurethral procedures performed in the past, with no relation to type of anaesthesia (p < 0.05).ConclusionsAnaesthesia of the posterior urethra is not more efficacious in reducing pain related to cystoscopy than standard instillation of anaesthetic gel. However, it improves the general perception of the procedure, and hence may positively influence patients’ compliance.

Vitamin A deficiency (VAD) is a major health problem in children world wide. For its diagnosis, all the available methods such as clinical surveys, dietary assessment, measurement of serum vitamin A, relative dose response test and determination o f liver vitamin A concentration (LVAC) have serious theorical or practical shortcomings. IC is a new non invasive method based on the change of epithelial surface which undergo keratinisation and metaplasia in absence of vitamin A. A mil lipore paper is grasped with finger on the temporal bulbar conjonctiva during 3 seconds. The paper is removed, pressed on a glass slide for transferring the cells. After fixation and a special short staining, the cells are examined under light microscope. To assess the value of this new method, we applied it to 30 children with liver disease whose LVAC had been determined on liver biopsy. In 22 children with normal LVAC, IC showed numerous goblet cells and small normal epithelial cells. In 8 cholestatic children with VAD, (LVAC < 20 ng/g), IC showed absence of goblet cells and enlarged epithelial cells. The results indicate that IC is a reliable method for detection of VAD based on a simple test: the absence of goblet cells. This may prove useful both for mass surveys in developing countries as well as for control of VAD in children with liver or gastrointestinal disease.Royal Victoria Infinmy, Newcastle upsn m e , UK Infomtim is limitcd cmccming thc lug tern prqposis for pediatric peptlc ulccr disease. We tracd 19 individuals i n whan this diagnosis had bxn made 1'4 to Ti years earlier. All had ken diagnosed using strict criteria. Fach ccnpletcd a pstal qicsticmaire and wherc necessary kther information wasobtaincd by direct intervim or discussim with the general practitimer. lbspital case notes, f' mn adult life, were studicd whem these were available.At follow up the subjects rangcd fran 25 to 58 ( d i m 30) years old. A hi& incidence of mrbidity prsisting into adult life was f w d . Nine (47%) had had a proven ulccr r c m n c e since entering adult life. 'Ten (53%) were no lcngcr p m e to recurring cpiscdes of atduninal pain, b t ' 40% of these had mdergcne vagotcqy and pyloroplasty for intractable s m t m . ?bus mly six patients (31%) had rrwrlc a lasting and spcntaneous mcovery. Canplicatims such as hacmorrhage. penetrating ulcer, severe pyloric stenosis or perforation had K C & i n 10 (53%). Sevm (37%) had undergcnc surgery, and in two of these cases rrure ttm m e operatim hid ken perfod. i:ifty-cight pcrcent of cqlicatims suffered and 89% of m i c a 1 operatims performed involved patients of 21 years or older.'Ihese findings firmly reinforce the opinim that the disorder Wquently persists into adult life. 'I'k W c t of the newer means of medical therapy, such as the ti reccptor antagmists roMins to h evaluated. 2 LYMPHOCYTES, LYMPHOCYTE SUBGROUPS, IFV.1UNOGLOBULIN-CONTAINING CELLS AND HLA-OR EXPRESSiON IN THE RECTALDept. of Paediatrics, University of Helsinki, Finland Lymphocyte subpopulations, plasma cells and the expression ...