BACKGROUND Evidence of systemic inflammation, i.e., elevation of serum C–reactive protein, interleukin‐6, and/or the erythrocyte sedimentation rate, is correlated to poorer prognosis of patients with renal cell carcinoma (RCC). Serum amyloid A (SAA) has been recognized mainly as acute‐phase reactant. METHODS Serum SAA from 72 patients with RCC were examined. Thirty‐eight of 72 patients with RCC had elevated SAA compared with 17 healthy donors. RESULTS The disease specific survival rate was significantly lower in the elevated SAA group, and SAA level was shown to be an independent prognostic factor by univariate and multivariate analysis. CONCLUSIONS Evaluation of serum SM level in RCC patients may be a useful prognostic indicator. Cancer 2001;92:2072–5. © 2001 American Cancer Society.

From January 17, 1992 to January 16, 1993, laparoscopic adrenalectomy was performed in 7 patients (3 men, 4 women) with primary aldosteronism ranging in age from 35 to 65 years (mean 48.7 years). Five of the adrenal lesions were on the left side and two were on the right. Five to six trocar-sheath units were used, and adrenal tumors were successfully removed with adjacent normal adrenal glands in all patients. The operative time ranged from 165 to 572 min (mean 302 min), operative blood loss was between 50 and 450 ml (mean 217.2 ml), and there was no major complication. In conclusion, laparoscopic adrenalectomy is a safe alternative operative method for primary aldosteronism, although application of this technique to other types of adrenal lesions remains to be examined.

Retroperitoneal laparoscopic adrenalectomy is feasible for primary aldosteronism. However, Cushing's syndrome is presently a much more difficult indication than primary aldosteronism for this new operative technique.

Summary An immunohistochemical study of the expression of epidermal growth factor receptor (EGFR) and c-erbB-2 protein was performed in fresh-frozen sections from 30 patients with transitional cell cancers (TCCs) of the upper urinary tract (15 renal pelvic cancers, 15 ureteral cancers) who underwent total nephroureterectomy. We followed them and examined whether TCC appeared in the urinary bladder. The follow-up period ranged from 116 to 2348 days (mean 666 days). (Mori et al., 1989). Therefore, this protein has been assumed to be a growth factor receptor that plays a role in mitogenic signalling in the fetal epithelium. The overexpression of c-erbB-2 has been shown to be correlated with lymph node metastasis and a poorer prognosis in those with breast cancer, suggesting that c-erbB-2 may play an important role in the progression of cancers (Slamon et al., 1987;Walker et al.. 1989).Transitional cell cancers (TCCs) in the urinary tract appear to occur multicentrically. After a total nephroureterectomy for TCCs of the renal pelvis or ureter, patients require continued surveillance, because the incidence of a subsequent bladder cancer is about 20-40% (Batara and Grabsteld, 1976;Kakizoe et al., 1980;Nielsen and Ostri, 1988;Catalona, 1992). Although several studies have been performed to determine the relationship between urothelial cancers of the upper urinary tract and secondary urinary bladder cancers after total nephroureterectomy, none of the criteria examined was found to be predictive of recurrence in urinary bladder. We reported that EGFR and c-erbB-2 were also overexpressed in TCCs in ureter or renal pelvis, and that the degree of expression was correlated with the histopathological grade of the tumour and the degree of invasion (Kimura et al., 1992). In this study. our interest was focused on correlation between the degree of expression of EGFR or c-erbB-2 and recurrence in the urinary bladder after surgical removal of TCCs in ureter or renal pelvis. Our data show that recurrence in the bladder occurs more frequently in patients with EGFR-and/or c-erbB-2-overexpressing TCCs of the upper urinary tract. Materials and methods PatientsThirty patients (24 males and six females; mean age 67.9 years, range 53-81) who had undergone total nephroureretectomy for renal pelvic (15 cases) or ureteral cancer (15 cases) were admitted to this study. All the tumours were diagnosed pathologically as TCC. The patients were not treated with either chemotherapy or radiotherapy before surgery. Patients with bladder cancer or distant metastasis before surgery or with lymph node metastasis identified by histopathology after surgery were excluded from this study. Seven patients had no invasion of the lamina propria (pTa), eight showed lamina propria invasion (pTl), seven had invasion of superficial muscle (pT2) and eight had invasion of the deep muscle (pT3). Pathological grade 1 tumours (high differentiation) occurred in five patients, grade 2 (moderate differentiation) in 20 and grade 3 (poor differentiation) in five. Immunope...

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