The objective of this study was to define the prognostic significance of surgical center case volume on outcome for head and neck cancer (HNC). Florida cancer registry and inpatient hospital data were queried for HNC diagnosed from 1998 to 2002. Of the 11,160 operative cases of HNC identified, 35.3% were treated at low-volume centers (LVCs), 32.7% in intermediate-volume centers (IVC), and 32.1% at high-volume centers (HVC). A larger proportion of high-grade tumors (27.9%) and lesions over 30 mm (39.7%) were resected at HVC (p < 0.001). Median survival was 61 months for HVC, 52 months for IVC, and 47 months for LVC (p < 0.001). Univariate analysis demonstrated significantly improved survival at HVC for low-, medium-, and high-grade tumors, small tumors (<30 mm), and for cancers of the parotid, larynx, and pharynx. On multivariate analysis, corrected for patient comorbidities, treatment at a HVC was a significant independent predictor of improved survival (HR = 1.25, p = 0.001). We conclude that HNC patients treated at HVC have significantly better long-term survival and cure rates. Where possible, patients with large (>30 mm), high-grade or parotid, larynx, and pharynx tumors should be evaluated and offered care at a high-volume center.

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WE have recently seen an unusual case of bilateral hydrocele in a Japanese infant in which the hydrocele communicated with the peritoneal cavity and contained a material which appeared to be meconium. The following is a case report with a discussion of the ztiology of this phenomenon.

TWENTY-ONE cases of renal cell carcinoma in a solitary kidney have appeared in the literature. Six additional cases are being reported. The chief interest of these tumours lies in their unpredictable biological behaviour which sometimes impels the urologist to exert unorthodox methods of surgical attackNo. 011-63-23, a 52-year-old Caucasian man, had intermittent hamaturia for 18 months. When blood first appeared investigation suggested congenital absence of the left kidney and an enlarged right kidney. A kidney needle biopsy was performed by the referring urologist and this showed hypernephroma. The patient had lost 15 lb. in weight. There were no pathological findings in the chest, but in the right upper abdomen there was a slightly tender and movable round mass.Urinalysis showed two to three red blood cells per high-powered field; the sedimentation rate was 32 mm. per hour. P.S.P. in 30 minutes was 35 per cent.An arteriogram confirmed absence of the left kidney and in the lower half of the right kidney the architecture was distorted by a mass which was not richly vascularised and which failed to show " tumour laking ". Skeletal survey showed no metastases. A retrograde pyelogram disclosed distortion of the right calyceal system by a mass occupying the entire half of the right kidney. Exploration proved involvement of the kidney by a large clear cell carcinoma which had spread to lymph nodes in the pericaval chain. No attempt was made t o resect the tumour. Silver clips were applied to the mass to direct radiation therapy. The patient had an uneventful post-operative recovery and radiation therapy to the right kidney region was started 10 days after his operation. He received a series of 17 treatments with Cobalt 60 teletherapy (3,500 rads).Therapy was discontinued because of anorexia and malaise. Three months later his N.P.N. was found to be 63 mg. per 100 ml., blood urea nitrogen was 35 and creatinine 3.7.The patient lived for one and one-half years following his operation and radiotherapy, finally succumbing to carcinoma spread.Case 2.-F. S., V.A. No. 2571, a 51-year-old Caucasian man, complained of blood in the urine and right flank pain. The symptoms first occurred eight months prior to admission at which time an intravenous urogram showed absence of the left kidney and a stone in the right ureter. The calculus was removed cystoscopically. Seven additional hospitalisations were required because of hamaturia and right flank pain. Two weeks prior

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