INTRODUÇÃO: Estenose ureteral e ureterohidronefrose podem ser sérias complicações da cirurgia reconstrutiva aorto-femoral ou aorto-ilíaca. RELATO DE CASO: Uma paciente de 62 anos apresentou-se referindo história de dor lombar a esquerda há seis meses. Ela era fumante, portadora de hipertensão arterial crônica leve e arterite de Takayasu. Havia sido submetida a três intervenções vasculares. Em dois procedimentos o uso de prótese de Dacron foi necessário. Uma urografia excretora revelou moderada ureterohidronefrose à esquerda e falha de enchimento no ureter próximo ao cruzamento dos vasos ilíacos. Esse achado era compatível com uma estenose ureteral e o enxerto aorto-ilíaco poderia ser a causa do processo inflamatório. A paciente foi submetida a laparotomia, que evidenciou a relação entre estenose ureteral e a prótese vascular. Ureterectomia segmentar e uretroplastia término-terminal com o ureter passando anteriormente à prótese foram realizadas. Não ocorreram complicações. Os períodos de pós-operatório precoce e tardio transcorreram sem intercorrências. A paciente evoluiu bem e uma nova urografia excretora apresenta-se normal. Concluímos que ureterohidronefrose sintomática após enxerto aorto-ilíaco é uma complicação real e precisa ser rapidamente diagnosticada e tratada pelo urologista.

CONTEXT: Ureteral stenosis and ureterohydronephrosis may be serious complications of aortoiliac or aortofemoral reconstructive surgery. CASE REPORT: A 62-year-old female patient presented with a six-month history of left lumbar pain. She was a smoker, and had mild chronic arterial hypertension and Takayasu arteritis. She had previously undergone three vascular interventions. In two procedures, Dacron prostheses were necessary. Excretory urography showed moderate left ureterohydronephrosis and revealed a filling defect in the ureter close to where the iliac vessels cross. This finding was compatible with ureteral stenosis, and the aortoiliac graft may have been the reason for this inflammatory process. The patient underwent laparotomy, which showed that there was a relationship between the ureteral stenosis and the vascular prosthesis. Segmental ureterectomy and end-to-end ureteroplasty with the ureter crossing over the prosthesis anteriorly were performed. There were no complications. The early and late postoperative periods were uneventful. The patient evolved well and the results from a new excretory urogram were normal. We concluded that symptomatic ureterohydronephrosis following aortoiliac graft is a real complication and needs to be quickly diagnosed and treated by urologists.

Objetivo: Mostrar uma casuística de pacientes com timoma, tratados cirurgicamente, com ou sem outra terapia associada, no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Sudeste do Brasil, avaliando o prognóstico destes. Métodos: Entre 1965 e 1998 foram operados 104 pacientes com neoplasias do timo, sendo 69 (66,3%) do sexo masculino; a idade média ao diagnóstico foi de 47,9 ± 16,3 anos, com faixa de variação de 13 a 76 anos de idade. Resultados: Dos 104 operados, 89 (85,6%) foram submetidos a ressecção total do timoma, 6 (5,8%) a ressecção parcial e 9 (8,6%) a biópsia. O diagnóstico anatomopatológico (timoma x timoma maligno) e a cirurgia (biópsia x ressecção total x ressecção parcial) foram significativamente preditivos (p < 0,02) para o tempo médio de sobrevida. Conclusão: A ressecção completa é o tratamento de escolha para os timomas. Esses tumores, quando não invasivos e ressecados completamente, apresentam bom prognóstico imediato e tardio.

Objectives: To describe a group of patients with thymoma who were submitted to surgical treatment associated or not with therapy, and evaluate their prognosis. Methods: Of the 104 patients with thymic tumors who were operated at Hospital das Clínicas São Paulo University Medical School between 1965 and 1998, (66.3%) were males. Mean age at diagnosis, was 47.9% ± 16.3 years (ranging from 13 to 76 years). Results: Of the 104 patients, 89 (85.6%) underwent complete thymoma resection, 6 (5.8%) underwent partial resection and, in 9 (8.6%) of them, biopsy was performed. Anatomopathologic diagnosis (thymoma vs malignant thymoma) and the type of surgery (biopsy vs complete resection vs partial resection) were significant predictors of survival mean time (p < 0.02). Conclusions: Complete resection is the treatment of choice for thymomas. These tumors, when not invasive and completely resected, have good immediate and late prognosis.

A 38-year-old male underwent coronary artery bypass grafting (CABG). A saphenous vein graft was attached to the left marginal branch. The left internal thoracic artery was anastomosed to the left anterior descending artery (LAD). The early recovery was uneventful and the patient was discharged on the 5th postoperative day. After three months, he came back to the hospital complaining of weight loss, weakness, and dyspnea on mild exertion. Chest X-rays showed left pleural effusion. On physical examination, a decreased vesicular murmur was detected. After six days, the diagnosis of chylothorax was made after a milky fluid was detected in the plural cavity and total pulmonary expansion did not occur. On the next day, both anterior and posterior pleural drainage were performed by videothoracoscopy, and prolonged parenteral nutrition (PPN) was instituted for ten days. After seven days the patient was put on a low-fat diet for 8 days. The fluid accumulation ceased, the drains were removed and the patient was discharged with normal pulmonary expansion.