RESUMO Introdução: a cirurgia retrógrada intrarrenal (CRIR) é ferramenta em evolução. Sua curva de aprendizado não está bem estabelecida, apesar do uso comum dos ureteroscópios flexíveis atualmente. O objetivo é estimar o número de procedimentos necessários para se realizar CRIR consistentemente. Material e Métodos: Um residente de urologia teve suas primeiras 80 CRIR para tratamento de nefrolitíase analisadas quantitativa e qualitativamente. Os procedimentos foram divididos em 4 grupos contendo 20 cirurgias cada (I a IV), de acordo com sua ordem, para comparação. Resultados: Não houve diferença nos tamanhos dos cálculos entre grupos. Todas as variáveis qualitativas apresentaram variação significativa entre os grupos (p<0,001), exceto entre III e IV. Na análise quantitativa houve diferença entre os grupos I e IV no tempo de colocação do cateter duplo J (p=0,012). Houve uma diferença crescente no tempo de colocação da bainha (p<0,001) e no tempo operatório total (p=0,004). O tempo para o tratamento do cálculo (p=0,011) foi significativo apenas entre os grupos I, II e III. Houve diferença no tempo total de bainha apenas entre os grupos I e III (p=0,023). Taxa livre de cálculos não se alterou entre os grupos. Discussão: as diferenças observadas entres as variáveis qualitativas e quantitativas evidenciam a relação entre o número de cirurgias realizadas e a proficiência no procedimento. As comparações intergrupo mostram otimização sequencial dos parâmetros. Conclusões: estima-se que 60 é um número razoável de cirurgias para que se atinja o platô da curva de aprendizado.

ABSTRACT Introduction: retrograde intrarenal surgery (CRIR) is an evolving tool. Its learning curve is not well established, despite the common use of flexible ureteroscopes today. Our aim is to estimate the number of procedures needed for one to perform RIRS consistently. Material and Methods: a urology resident had his first 80 RIRS for nephrolithiasis analyzed quantitatively and qualitatively. The procedures were divided into 4 groups containing 20 surgeries each (I to IV), according to their order, for comparison. Results: there was no difference in stone sizes between groups. All qualitative variables varied significantly between groups (p<0.001), except between III and IV. In the quantitative analysis, there was a difference between groups I and IV in time for double-J catheter placement (p=0.012). There was an increasing difference in sheath placement time (p<0.001) and in total operative time (p=0.004). The time fot stone treatment (p=0.011) was significant only between groups I, II and III. There was difference in total sheath time only between groups I and III (p=0.023). Stone free status did not change between groups. Discussion: the differences between the qualitative and quantitative variables show the relation between number of surgeries performed and proficiency in the procedure. Intergroup comparisons show sequential optimization of parameters. Conclusions: we found that 60 is a reasonable number of surgeries to be performed in order to reach the plateau of RIRSs learning curve.

Resumo O Programa de Expansao e Melhoria da Educando no Meio Rural (Edurural) foi um projeto financiado pelo Banco Mundial com o objetivo de melhorar a aprendizagem dos estudantes da regido Nordeste do Brasil. Este artigo apresenta este programa como uma experiencia brasileira pioneira em avadando em larga escala. Dessa forma, formos orientados pela seguinte pergunta: quais as características do Edurural o tornam uma experiencia pioneira em avadando educacional em larga escala no Brasil? Dessa forma, problematizamos esse programa e expomos o contexto de planejamento e execundo com enfase no projeto de avaliando educacional que teve foco nos aspectos institucionais, tais como infraestrutura, qualificando docente e materiais didáticos, e de rendimento educacional em portugues e matemática dos estudantes envolvidos. Apresenta ainda, uma breve síntese dos resultados com base em publicares dos pesquisadores envolvidos na realizando dessa avaliando realizada na regido do nordeste brasileiro.

Abstract The Northeast Rural Primary Project was financed by the World Bank with the objective of improving the learning of students in the Northeast of Brazil. This article presents this program as a pioneering Brazilian experience in large-scale evaluation. This essay tries to answer the following question: What are the characteristics of Edurural that make it a pioneering experience in large-scale educational evaluation in Brazil? In this way, this program has been problematized its planning and execution context has been exposed, with emphasis on the educational evaluation project that focused on institutional aspects such as infrastructure, teacher qualification and didactic materials, and educational achievement in Portuguese and mathematics of the students involved. Yet, it also presents a brief summary of the results based on the researchers publications who were involved in this evaluation carried out in the northeast region of Brazil.

Resumen El Programa de Expansión y Mejora de la Educación del Medio Rural (Edurural) fue un proyecto financiado por el Banco Mundial con el objetivo de mejorar los aprendizajes de los estudiantes de la región Nordeste de Brasil. Este artículo presenta ese programa como una experiencia brasileña de evaluación de larga escala. De esta manera, nos orientamos por la siguiente pregunta: ¿cuáles fueron las características de Edurural que lo convirtieron en una experiencia pionera en evaluación educacional de larga escala en Brasil? En este sentido, problematizamos ese programa y exponemos el contexto de planeamiento y ejecución con énfasis en un proyecto de evaluación educacional que tiene foco en aspectos institucionales tales como la infraestructura, la calificación docente y los materiales didácticos, y en el rendimiento educacional en portugués y matemáticas en los estudiantes involucrados. Además, se presenta una breve síntesis de los resultados, basada en las publicaciones de los investigadores participantes de la evaluación realizada en la región del nordeste brasileño.

INTRODUCTION: Cell adhesion molecules (CAM) are required for maintaining a normal epithelial phenotype, and abnormalities in CAM expression have been related to cancer progression, including bladder urothelial carcinomas. There is only one study that correlates E-cadherin and α-, β- and γ-catenin expression with prognosis of upper tract urothelial carcinomas. Our aim is to study the pattern of immune expression of these CAMs in urothelial carcinomas from the renal pelvis and ureter in patients who have been treated surgically. Our goal is to correlate these expression levels and characteristics with well-known prognostic parameters for disease-free survival. MATERIALS AND METHODS: We evaluated specimens from 20 patients with urothelial carcinomas of the renal pelvis and ureter who were treated with nephroureterectomy or ureterectomy between June 1997 and January 2007. CAM expression was evaluated by immunohistochemistry in a tissue microarray and correlated with histopathological characteristics and patient outcomes after a mean follow-up of 55 months. RESULTS: We observed a relationship between E-cadherin expression and disease recurrence. Disease recurrence occurred in 87.5% of patients with strong E-cadherin expression. Only 50.0% of patients with moderate expression and 0% of patients with weak or no expression of E-cadherin had disease recurrence (p = 0.014). There was also a difference in disease-free survival. Patients with strong E-cadherin expression had a mean disease-free survival rate of 49.1 months, compared to 83.9 months for patients with moderate expression (p = 0.011). Additionally, an absence of α-catenin expression was associated with tumors that were larger than 3 cm (p = 0.003). CONCLUSIONS: We demonstrated for the first time that immune expression of E-cadherin is related to tumor recurrence and disease-free survival rates, and the absence of α-catenin expression is related to tumor size in upper tract urothelial carcinomas.

A case of primary extragonadal yolk sac tumor in the retroperitoneum of a young adult male is reported. The symptoms were melena and weakness for two months. Radiologic studies suggested a retroperitoneal tumor infiltrating the duodenum, artery aorta and vein cava, was found. Partial resection was performed, remaining tumor around the vessels. Microscopic examination disclosed a yolk sac tumor infiltrating the duodenum. The patient was managed unsuccessfully with radiotherapy, but good results were actived with chemotherapy. Few cases like that were reported in the literature.