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296 solid renal tumors were studied retrospectively, i.e. the total number of renal tumours diagnosed in the Indre-et-Loire region between 1980 and 1987 inclusive. The crude incidence rate increased from 5.4 per 100,000 in 1980 to 8 per 100,000 in 1987. The standardised rates were 6.7 per 100,000 for men and 3.2 per 100,000 for women. These figures being quite high for France. The mean age at the time of diagnosis, 67 years for women and 65 years for men, decreased during the study, especially for women. Patients in whom the renal cancer was discovered accidentally, tended to be older than those in whom the tumour was symptomatic. The percentage of tumours discovered at stage I rose from 29 to 49% the percentage of tumours at stage IV fell from 45 to 23.5%. In parallel, the percentage of nephrectomies rose from 40 to 70%. The overall 5 year survival rate was 43.5%, rising to 71% for stage I tumours. It appeared that patients who consulted in the private sector tended to be younger and were therefore at an earlier stage in the natural history of the disease. From an epidemiological viewpoint, the introduction of ultrasonography in the Indre-et-Loire region and its more widespread use did not produce any change in the means of diagnosis of renal cancer.

Of 220 solid tumors of renal parenchyma reviewed, 26% (57 tumors) were asymptomatic and discovered by chance, either by radiology (45.5%), ultrasound (21%), biology (16%), clinical (10.5%) or histopathology examination (7%). The asymptomatic tumors were benign in 20% of cases whereas this was the case with only 3% of symptomatic tumors. For a given age, asymptomatic malignant tumors were in a less advanced stage than symptomatic tumors. These findings suggest the need for routine investigation for renal tumor syndromes. Whenever possible and whatever the indication for an examination.

Metastatic cancer of the kidney kills one half of the patients concerned within one year and there are no survivors two years later. All of the treatments used up until the present time have been disappointing. Nephrectomy does not prolong survival, does not induce regression of metastases and does not modify the mode of metastatic dissemination. It only has a palliative role. Lymphadenectomy associated with nephrectomy only has a prognostic value. Hormone therapy and chemotherapy are ineffective. Resection of a single metastasis is justified by 5-year survival rates of 30 to 50% in certain series. At the present time, the hopes for effective treatment are raised by the use of recombinant alpha interferon. Therapeutic trials obtain an overall complete response rate of 2.5% (disappearance of all signs of tumour for 4 weeks) and a partial response rate of 14% (decrease in the neoplastic lesions by at least 50%). The combination of interferon with vinblastine ensures much better results with complete and partial response rates of up to 43%. The characteristics of responder patients are discussed in terms of the natural history of renal cancer and the respective results of other treatments. There is a sub-population of patients with metastatic renal cancer suitable for this combination of interferon-vinblastine: they are young patients, in good general condition, previously nephrectomised and preferably suffering from lung metastases. The essential limiting factor of this treatment is the high cost of interferon.

A further case is reported of urinary tract lithiasis developing around a metallic clip used to suture an ileal fragt during Bricker's operation. Although the calculus developed without provoking complications and was evacuated spontaneously through the stoma, the question is asked, after a literature review, whether it is justified to use mechanical suturing for transintestinal cutaneous anterostomies. The moderate gain in time (15 to 20 min) seems counterbalanced by the increased cost and definite risk (2 to 4%) of lithiasis on metallic clips.