Metastatic potential in renal cell carcinomas ≤7 cm: Swedish Kidney Cancer Quality Register data.

BACKGROUND: Renal cell carcinoma (RCC) represents 2-3% of all malignancies and accounts for approximately 90% of all kidney malignancies. An increasing proportion of RCCs are discovered incidentally, and the average tumor diameter at diagnosis has decreased over the last few decades. Small RCCs have often been regarded by many as relatively harmless. OBJECTIVE: The objective was to evaluate the incidence of local T-category distribution and lymph node and distant metastases in relation to tumor size in RCCs ≤7 cm in a nationally based patient population. DESIGN, SETTING, AND PARTICIPANTS: Data were extracted from the National Swedish Kidney Cancer Register containing 3489 RCCs diagnosed between 2005 and 2008. This is a population-based registry including 99% of all RCCs diagnosed nationwide. The study included 2033 patients having a tumor ≤7 cm in diameter. MEASUREMENTS: The size of the tumors was compared with sex, age, cause of diagnosis, Fuhrman grade, RCC type, and TNM category. RESULTS AND LIMITATIONS: Most RCCs were discovered incidentally and incidence correlated inversely to tumor size. There were 887 (43%) patients with category T1a tumors, 836 (40%) with category T1b, 174 (8%) with T3a, 131 (6%) with T3b/c, and 12 (1%) patients had invasion of adjacent organs (T4). A total of 309 (15%) patients had lymph node and/or distant metastases. Of the 177 1- to 2-cm RCCs, category T3 tumors were identified in three patients and lymph node and/or distant metastases were identified in 8 (5%). Only for tumors ≤1 cm was there neither advanced stage nor metastasis. The occurrence of locally advanced growth, lymph node and distant metastases, and high tumor grade correlated to tumor size. Patients with Fuhrman grade III or IV had a four-fold greater risk of metastases than grades I or II. CONCLUSIONS: Lymph node and distant metastases occur even in small RCCs. Risk of metastases increases with tumor size. The data clearly show that small RCCs also have a malignant potential and should be properly evaluated and adequately treated.

'Evaluation of Residencies' in Turkey. The first report of the ESRU questionnaire in the Europe 'home version'.

INTRODUCTION: We aimed to evaluate the general status of last-year residents in Turkey by filling in the questionnaire 'Evaluation of Residencies in Europe'. SUBJECTS AND METHODS: The questionnaire 'Evaluation of Residencies in Europe', designed by the European Society of Residents in Urology (ESRU), was applied to 91 last-year urology residents. It consisted of 7 sections; 'Introduction', 'Membership', 'Residency', 'Life and Financial Conditions', 'Future Practice', 'Training' and 'Research Activities and Contribution to Scientific Literature'. The results were determined and reviewed as well. Statistical analysis was performed using ANOVA and the Kruskal-Wallis Test. RESULTS: More than 40 parameters were evaluated. The level of English was average or good for 86%. Half of the residents were aware of ESRU activities, 91% knew national ESRU representatives. Fifty-seven percent of the residents wanted to subspecialize in urology, nephrectomy or andrology, and general urology procedures had a high rate being performed by a first surgeon. Transurethral prostate resection, transurethral resection of bladder and extracorporeal shock wave lithotripsy were well known, with a rate of 76%. CONCLUSIONS: Although the Turkish resident number is one of the most excessive in Europe, we have a well-trained homogenous resident group especially in the field of endourology; most of those in the last year of their training period were satisfied with their general condition.

Comparison of the self-reported training level between Mexican and Western Europe residents in urology: results of an international survey.

OBJECTIVE: To find out how Mexican residents in urology perceive their own level of training in comparison with how residents in Europe perceive theirs. METHODS: A questionnaire of self-assessment was distributed to 104 European and 24 Mexican urologists-in-training. We assessed the perception of residents about their level of training and factors associated with self-perceived performance. RESULTS: Mean age of 128 residents was 32.69 +/- 3.33 years. Mexican residents spent significantly more time in urological departments than European residents. The weekly amount of hours spent at work was higher in Europe; while the number of residents per hospital was higher in Mexico. Mexican residents reported more reliable support from a supervising senior. European residents perceived they had a superior level regarding transplantation in female urology and urinary lithiasis, whereas Mexican residents felt more confident regarding urological infections and paediatric urology. Factors associated with better self-perceived performance were the number of months in urology, the number of non-urologic rotations and a supervising senior. CONCLUSION: Mexican residents in urology perceive that their own level of training is similar to that of European residents. The number of months of training in urology, the number of non-urologic rotations and a supporting senior are associated with a better self-perceived performance.

[Abdominal tuberculosis--still a diagnostic challenge. Two case reports and a literature review]. / Abdominell tuberkulos--en nygammal diagnostisk utmaning Två fallbeskrivningar och en litteraturgenomgång.

Abdominal tuberculosis (TB) is unusual in Sweden today. This paper presents two patients born 1981 and 1975, one with perforated duodenal ulcer due to Helicobacter pylori and/or Mycobacterium tuberculosis. Acute operation with suture was done, signs of granulomatous inflammation revealed culture positive for TB. The other was operated with appendectomy; the pathology was TB in the mesenteries and outside the caecum. Antituberculosis chemotherapy was given in both cases and neither patient suffered any major problems. These two cases show how important it is for surgeons to be aware of TB nowadays, particularly in patients born outside Sweden or those undergoing immune therapy.