Symptomatology and Diagnosis.—It is often fairly difficult to determine whether a tumor in the region of the kidney is a renal tumor. Its relation to thc ascending, transverse and descending colon is con sidered a matter of importance. If these parts of the intestines are distended with gas, there will be found above the renal tumor a tym panitie sound, differing from the absolutely muffled sound usually heard, but von Leube describes appearances which differ from this. Where the tumor Call be distinctly outlined, and where the eourse has been free from fever, and moderate in its symptoms, we arc inclined to exclude paranephritic a bs c ess .
A cone-shaped, blunt end speaks against an en larged spleen, which has a wedg e-s ha p e d sharp edge. According to Is rael, we may remember in differentiating bet we e n renal and suprarenal tu mors, that a tumor of the kidneys is felt near the costal margin, between the ninth and eleventh rib, while the suprarenal turnor is palpable near the median line.
It is frequently possible to make a differ ential diagnosis from deeply seated tumors of the liver, or from masses of tuberculous gl a n cls, v,-hich latter must he es pecially borne in mind during infancy. Additional symptoms of importance are pains starting in the region of the loin and radiating towards the symphysis, and haima turia. The latter is said to be more common in carcinoma than in sar
coma, and may be the first symptoms of a renal nature. It is worthy of mention that Israel has described ha-maturia in connection with supra renal tumor, which resulted from the invasion with compression and thrombosis of the vena cava and renal vein with interference with the venous drainage from the kidney. The accompanying general symptoms are emaciation, decline and gastro-intestinal disturbances The tumor still remains the most important symptom for the establishment of a diagnosis. The larger it is, the easier is it to prOVC its presence by palpation. In two cases Israel diagnosed by palpation, sarcomas of the size of ft cherry kernel. It is exceedingly rare that any- one is able to recognize tumor particles in the urine. The X-rays are of value in differentiating from calculi.
Complications result from metastatic deposits, e.specially in the liver and in the lungs.
The prognosis without surgical intervention is absolutely hope less'. Death terminates the scene either in a few months, or at least within two years. Operation which predisposes a healthy condition of the other kidney may affect a lasting cure. Out of SS operated eases, investigated by Steffen, IS remained permanently free from recurrence.