ABSTRACT Hypothesis: Partial Nephrectomy is oncological safe in patients with pT3a RCC. Purpose: To compare the oncological and functional outcomes of patients with pT3a RCC scheduled for PN and RN. Materials and Methods: We retrospectively reviewed patients with pT3a N0 M0 RCC who underwent partial or radical nephrectomy from 2005 to 2016. Perioperative characteristics, including estimated glomerular filtration rate, tumor size, pathological histology, and RENAL nephrometry score, were compared between patients scheduled for partial or radical nephrectomy. We used multivariable Cox proportional hazards regression models to compare overall survival, cancer-specific survival, and recurrence-free survival between planned procedure type. Results: Of the 589 patients, 369 (63%) and 220 (37%) were scheduled for radical and partial nephrectomy, respectively; 26 (12%) of the scheduled partial nephrectomy cases were intraoperatively converted to radical nephrectomy. After adjusting for tumor size and histology, there were no statistically significant differences in overall survival (hazard ratio 0.66; 95% CI, 0.38–1.13), cancer-specific survival (hazard ratio 0.53; 95% CI, 0.16–1.75), or recurrence-free survival (hazard ratio 0.66; 95% CI, 0.34–1.28) between patients scheduled for partial or radical nephrectomy. Fewer patients scheduled for partial nephrectomy had estimated glomerular filtration rate reductions 3 to 9 months after surgery than patients scheduled for radical nephrectomy. Conclusion: We found no evidence that patients scheduled to undergo partial nephrectomy had poorer oncologic outcomes than patients scheduled to undergo radical nephrectomy. In select patients with pT3a renal cell carcinoma in whom partial nephrectomy is deemed feasible by the surgeon, partial nephrectomy should not be discouraged.

ABSTRACT Extranodal NK/T-cell lymphoma, nasal type (ENKTL-NT) is a rare type of Non-Hodgkin’s lymphoma, which usually presents with extranodal involvement and affects the nasal/upper aerodigestive tract in the classical presentation. Herein, we report the case of a 31-year-old, previously healthy, male patient diagnosed with ENKTL-NT with the involvement of the lung parenchyma and heart. Unfortunately, due to the rapid disease progression, the diagnosis was performed only at the autopsy. The authors highlight the rare clinical presentation of this type of lymphoma, as well as the challenging anatomopathological diagnosis in necrotic samples.

RESUMO. A encefalite de Rasmussen (ER) é um distúrbio clássico da faixa etária infantil e apenas 10% dos casos são descritos em adultos. Trazemos dois casos comprovados de ER em idosos, com idade acima de 55 anos de idade. Objetivo: Descrever as características clínicas, evolução, avaliação diagnóstica, achados neuropatológicos e tratamento da ER em dois casos clínicos com mais de 55 anos de idade. Além disso, atentar para o declínio cognitivo progressivo como uma característica importante na apresentação ER idosos em associação à epilepsia focal. Métodos: Série de casos de dois Hospitais Terciários em São Paulo, Brasil. Dados retrospectivos foram coletados de um caso. Resultados: Dois indivíduos do sexo masculino com idade >55 anos e apresentação clínica de epilepsia focal associada a deterioração cognitiva progressiva. Conclusão: A ER pode ser considerada a causa do declínio cognitivo progressivo em idosos, especialmente se for descrita epilepsia focal associada a achados assimétricos em neuroimagem.

ABSTRACT. Rasmussen encephalitis (RE) is a classic disorder in the child age group, and only 10% of cases are described in adults. We bring two proven cases of RE in older adults aged over 55 years. Objective: To describe the clinical characteristics, progression, diagnostic assessment, neuropathological findings, and treatment of RE in two clinical cases of patients over 55 years of age. Furthermore, we address progressive cognitive decline as an important feature of the RE presentation in older adults in association with focal epilepsy. Methods: This is a case series from two tertiary hospitals from São Paulo – Brazil. Retrospective data were collected from one case. Results: Two male individuals aged >55 years with clinical presentation of focal epilepsy along with progressive cognitive deterioration. Conclusions: RE could be considered the cause of progressive cognitive decline in older adults, especially if focal epilepsy is described together with asymmetrical neuroimaging findings.

Objective: Analyze technical details and results of laparoscopic treatment of ureterolithiasis. Materials and Methods: Between January 2005 and August 2008 it was performed laparoscopic ureterolithotomy in 22 patients in our service. Two (9%) by retroperitoneal access and 20 (91%) by transperitoneal access. Mean size of the calculi was 15 mm. with a variation from 8 mm to 23 mm. The calculus were in the upper tract in 18 patients (81,8%) and in mid ureter in 4 patients (18,2), any of the calculus were in lower ureter. Most of calculi were obstructive stones for more than 2 months. Eight patients were submited a previous section of extracorporeal shockwave lithotripsy and 2 by extracorporeal shockwave lithotripsy plus ureterolithotripsy as a calculi treatment attempt. Twelve patients had a laparoscopic ureterolithotomy as a primary indication for treatment. Results: Laparoscopic ureterolithotomy was successful for 20 patients (90,9%), and the fails occurred in the beginning of our experiment. Mean operative time was 145 minutes with range from 70 to 240 minutes. The indwelling ureteral stent was used in 03 cases; 02 preoperative, and 01 postoperative. The ureteral suture was performed with absorbable 4.0 separated stitches in all patients. The global average of permanence in hospital was 3,3 days and the drain permanence was 7,2 days. The global complication rate was 13,6%. The global rate of stone free was 91%, and there were residual stone in 2 patients. Conclusions: The laparoscopic treatment of ureterolithiasis besides minimally invasive, it is viable, secure and very effective. It should have taken into consideration as a procedure to extracorporeal shockwave lithotripsy and ureteroscopy. But, in cases where there are obstructive stones for a long time, in selected patients and, in special, in patients with just one kidney, it can be considered as a first line treatment. About the access, if retroperitoneal or transperitoneal; it is not still possible to affirm which would be the best one, the option must take into account the surgeon preference and experience.

Objetivo: Analizar detalles técnicos y resultados del tratamiento laparoscópico de la ureterolitiasis. Pacientes y Métodos: En el periodo de Enero de 2005 a Agosto de 2008, han sido realizadas 22 ureterolitotomías laparoscópicas (UL) en nuestro servicio; dos (9%) han sido por acceso retroperitoneal y 20 (91%) por acceso transperitoneal. La media de tamaño del cálculo fue de 15 mm, variando de 8 a 23 mm, y los cálculos estaban en uréter proximal en 18 pacientes (81,8%), uréter mediano en 4 pacientes (18,2%) y ninguno en uréter distal. La mayoría de los cálculos eran obstructivos había más que dos meses. Ocho pacientes han sido sometidos a sesiones previas de litotricia extracorpórea por ondas de choque y 2 a litotricia extracorpórea con ureterolitotricia en el intento de tratamiento de los cálculos. Doce pacientes han tenido ureterolitotomía laparoscópica como indicativo primario de tratamiento. Resultados: La ureterolitotomía laparoscópica alcanzó suceso en 20 pacientes (90,9%), siendo que ocurrieron fallas al inicio de nuestra experiencia. La media de tiempo operatorio fue de 145 minutos, variando de 70 a 240. Fue utilizado catéter doble j en 03 casos, siendo 02 en el preoperatorio y 01 en el postoperatorio. La sutura ureteral ha sido realizada con hilo absorbible 4.0, con puntos separados en todos los pacientes. La media global de permanencia hospitalaria fue de 3,3 días y la de tiempo de permanencia del dreno fue de 7,2 días. La tasa global de complicaciones fue el 13,6% y la de pacientes sin cálculo residual fue el 91%, siendo que hubo litiasis residual en 2 pacientes. Conclusiones: El tratamiento laparoscópico de la litiasis ureteral, además de mínimamente invasivo, es viable, seguro y bastante eficaz. Debe de ser considerado como un procedimiento de salvamento para la litotricia extracorpórea por ondas de choque y ureterolitotricia. Sin embargo, en casos en los que hay cálculos obstructivos desde hace mucho tiempo, en pacientes seleccionados y, especialmente, en aquellos con riñón único, puede ser considerado como tratamiento de primera línea. Cuanto a la vía de acceso; si retroperitoneal o transperitoneal; todavía no se puede afirmar cual sería la mejor, y la opción entre una u otra debe de ser realizada de acuerdo con la preferencia y experiencia del cirujano.