Restless legs syndrome describes a curious need to stretch and move in response to an unpleasant feeling in the legs. For most people who have this, as they are drifting off to sleep there is a twitch of the toe, foot and ankle followed by another and then another. The limb movements are strikingly periodic and are described as such by frustrated bed partners. The pathophysiology remains debated but is likely to involve dopaminergic dysfunction and ascending arousal systems. Despite a prevalence of 5-10% in the general population, the variable nature of symptoms and difficulty describing the dysaesthesia often leads to delay in treatment. This article outlines the diagnostic criteria, medication and comorbidities that modify symptoms, the impact of restless legs syndrome on health, and symptomatic management. Several licensed therapies are effective but the dopamine agonists in particular can cause challenging side effects and paradoxically worsen symptoms over time. Case histories are reviewed to guide physicians.George Armstrong was probably the first physician to practice exclusively as a paediatrician in this country. He published the first account of the postmortem appearance of congenital pyloric stenosis. This year marks the 300th anniversary of his birth.Vitamin D deficiency has become an increasing focus of clinical interest, especially in understanding its associations with obesity in adults. The pathological associations linking the two appear to demonstrate complex cellular inflammatory, hormonal and genetic pathways. Enhanced understanding at both microcellular and clinical levels will help clarify the role of obesity in the development of vitamin D deficiency.PURPOSE The clinicopathological features and treatment outcomes of plasmacytoid variant (PV)-urothelial carcinoma of the bladder (UCB) have not been fully understood. We aimed to evaluate the clinicopathologic characteristics and survival outcomes of PV-UCB as compared to conventional UCB (C-UCB). METHODS A systematic review was performed following the PRISMA guideline. PubMed/Medline, Embase, and Cochrane Library were searched up to June 2019. The differences in the clinicopathological features (≥stage pT3, lymph node metastasis, ureteral margin-positive, and perivesical soft tissue margin-positive status) and survival outcomes [overall mortality (OM) and cancer-specific mortality (CSM)] between PV-UCB and C-UCB were compared. The GRADE approach was used for rating the certainty of evidence. RESULTS A total of 8 studies were included. Patients with PV-UCB had a higher frequency of ≥stage pT3 (odds ratio [OR], 3.84; 95% confidence interval [CI], 1.63-9.03; p=0.002) and risk of lymph node metastasis (OR, 2.58; 95% CI, 1.15-5.76; p=0.02), ureteral margin-positive (OR 12.18; 95% CI, 4.62-32.13; p less then 0.00001), and perivesical soft tissue margin-positive (OR 12.31; 95% CI, 5.15-29.41; p less then 0.00001) status after radical cystectomy than those with C-UCB. Although there was no difference in CSM (hazard ratio [HR], 1.40; 95% CI, 0.82-2.40; p=0.22) between PV-UCB and C-UCB, PV-UCB had worse survival outcomes (OM) than C-UCB approaching the borderline of significance (HR, 1.62; 95% CI, 0.98-2.68; p=0.06) when adjusted for other clinicopathological characteristics. CONCLUSIONS PV-UCB was strongly associated with adverse clinicopathological features and worse OM compared to C-UCB after adjusting other clinicopathological parameters, and PV histology of UCB is an independent prognostic factor for overall survival.PURPOSE To investigate whether men with biopsy-verified low-grade cancer and a family history of lethal or advanced prostate cancer are at particularly high risk of harboring undetected high-grade disease. MATERIALS AND METHODS Upgrading and upstaging of prostate cancer is common after prostatectomy. In a nationwide population-based cohort, we identified 6 854 men with low-risk prostate cancer who underwent radical prostatectomy. Among them, 1 739 (25%) had a history of prostate cancer among a first-degree relative, and 289 (4%) had a first degree relative with lethal or advanced prostate cancer. RESULTS Compared with men with no familial occurrence of prostate cancer, the odds ratio (OR) for the risk of upstaging among men with a familial occurrence of high-risk or lethal prostate cancer was 1.06 (95% CI, 0.76-1.47). The corresponding OR for upgrading was 1.17 (0.91-1.50). CONCLUSIONS We found no association between family history of prostate cancer and upstaging or upgrading after radical prostatectomy.OBJECTIVE To analyze the oncological outcomes of men undergoing primary RPLND and characterize the use of adjuvant chemotherapy and template dissections. METHODS Retrospective review of Indiana University testis cancer database identified patients who underwent a primary RPLND between 01/2007 and 12/2017. Patients and providers were contacted to obtain information regarding adjuvant therapy, recurrence, and survival. XL184 Primary outcome was recurrence-free survival (RFS). Kaplan-Meier curves assessed survival differences stratified by pathologic stage, template of dissection, and use of adjuvant chemotherapy. RESULTS Overall, 274 patients were included. Most men presented with CS-I disease (214, 78%). A modified unilateral template was performed in 257 (94%) and bilateral template in 17 (6%). Overall, 148 (54%) and 126 (46%) of men had Pathologic Stage I (PS-I) and PS-II disease, respectively. Thirteen patients (10%) with PS-II disease were treated with adjuvant chemotherapy. With a median follow-up was 55 months, only 33 (12%) patients recurred. Of the 113 patients with PS-II disease who did not receive chemotherapy, 21 (19%) relapsed and 81% were cured were surgery alone and never recurred. No difference in RFS was noted between modified and bilateral template dissections. CONCLUSIONS The use of adjuvant chemotherapy has been minimal over the past decade. The majority (81%) of men with PS-II disease were cured with RPLND alone and were able to avoid chemotherapy. Modified unilateral template dissection provided excellent oncologic control while minimizing morbidity.