Oncology Gold Standard™ practical consensus recommendations 2016 for treatment of advanced clear cell renal cell carcinoma.

The Oncology Gold Standard (OGS) Expert Group on renal cell carcinoma (RCC) developed the consensus statement to provide community oncologists practical guidelines on the management of advanced clear cell (cc) RCC using published evidence, practical experience of experts in real life management, and results of a nationwide survey involving 144 health-care professionals. Six broad question categories containing 33 unique questions cover major situations in the routine management of RCC. This document serves as a ready guide for the standard of care to optimize outcome. The table of "Take Home Messages" at the end is a convenient tool for busy practitioners.

Internal herniation of wandering spleen--a rare cause of recurrent abdominal pain.

A rare case of wandering spleen herniating through a defect in transverse mesocolon, which was managed electively by splenopexy using polyglycolic acid mesh is reported. An enlarged wandering spleen is at constant risk of trauma, torsion and infarction. Internal herniation seems to increase the above risks. Early recognition and elective splenopexy should be the treatment of choice.

Percutaneous nephrolithotomy for large and staghorn calculi.

The treatment of choice for a stone load of up to 3 cm is indubitably extracorporeal shock wave lithotripsy (SWL). However, for larger stones, and particularly staghorn calculi, the choice is not that clearcut. Our experience with percutaneous nephrolithotomy (PCNL) for a stone load larger than 3 cm in 878 renal units over 9 years has left us convinced that a well-planned and determined effort at percutaneous clearance is the best option for these difficult cases. Our overall complete clearance rate in this group is 93% and ranges from 98.5% for solitary calculi to 71% for complete staghorn calculi. These results are comparable to those reported by other workers with percutaneous monotherapy and are superior to those achieved by SWL monotherapy. The complication rate was acceptably low at 4%. We conclude that the expeditiousness and the better stone-free rates of PCNL justify the slightly higher morbidity that it entails when compared with SWL monotherapy. We also prefer to aim for total clearance percutaneously, leaving for SWL only those stones that defy our best efforts.

Transitional cell carcinoma involving the prostate.

Transitional cell carcinoma involving the prostate gland was studied in 27 patients. Three different groups were recognised on the basis of the clinical pattern and histological findings. Each group has a different prognosis and merits a different approach to treatment. Thus, stromal involvement of the prostate by transitional cell carcinoma is a sinister finding that requires radical treatment, whereas ductal involvement by either carcinoma in situ or non-invasive papillary tumours can be managed less aggressively. This study emphasises that the present classification for these tumours is unsatisfactory and that adequate histopathological information is essential for their management.