ABSTRACT This study aimed to report the first case of a patient with hepatosplenic schistosomiasis mansoni, refractory ascites and portal vein thrombosis treated with a transjugular intrahepatic portosystemic shunt (TIPS), at the Instituto de Radiologia, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Brazil. After the procedure, the patient recovered favorably and progressed with portal pressure reduction and no deterioration of the liver function. Endovascular shunt modification is a conservative medical approach that often helps in reducing symptoms significantly, making it a less invasive and a safer alternative to liver transplantation for the treatment of schistosomiasis with portal hypertension.

Resumo O objetivo deste estudo foi comparar a simulação de realidade virtual com outros métodos de aprendizagem na radiologia intervencionista. Foram realizadas buscas nas bases de dados eletrônicas Cochrane Library, Medline (PubMed), Embase, Trip Medical, Education Resources Information Center, Cumulative Index to Nursing and Allied Health Literature, Scientific Electronic Library Online, e Latin-American and Caribbean Health Sciences Literature para estudos comparando a realidade virtual com outros métodos de aprendizagem na radiologia intervencionista. Esta revisão sistemática foi realizada de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses e a Best Evidence Medical Education (BEME) Collaboration. Os estudos elegíveis foram avaliados usando o questionário de Buckley no BEME Guide nº 11 e o modelo de Kirkpatrick. Cinco ensaios clínicos randomizados foram incluídos nesta revisão, após a aplicação de todos os critérios de elegibilidade e qualidade. O nível de evidência educacional encontrado entre os artigos variou, sendo três estudos nível 2B e os demais nível 4B de acordo com o modelo de Kirkpatrick. Não houve divergência entre os estudos de que a realidade virtual agrega conceitos e é benéfica para o ensino da radiologia intervencionista. O uso da realidade virtual para aquisição de conhecimento e aprendizagem em radiologia intervencionista tem se mostrado eficaz, mas ainda faltam estudos que avaliem e estruturem a utilização dessa tecnologia em relação aos inúmeros procedimentos existentes no campo de atuação.

Abstract The aim of this study was to compare virtual reality simulation with other methods of teaching interventional radiology. We searched multiple databases-Cochrane Library; Medline (PubMed); Embase; Trip Medical; Education Resources Information Center; Cumulative Index to Nursing and Allied Health Literature; Scientific Electronic Library Online; and Latin-American and Caribbean Health Sciences Literature-for studies comparing virtual reality simulation and other methods of teaching interventional radiology. This systematic review was performed in accordance with the criteria established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Best Evidence Medical Education (BEME) Collaboration. Eligible studies were evaluated by using the quality indicators provided in the BEME Guide No. 11 and the Kirkpatrick model of training evaluation. After the eligibility and quality criteria had been applied, five randomized clinical trials were included in the review. The Kirkpatrick level of impact varied among the studies evaluated, three studies being classified as level 2B and two being classified as level 4B. Among the studies evaluated, there was a consensus that virtual reality aggregates concepts and is beneficial for the teaching of interventional radiology. Although the use of virtual reality has been shown to be effective for skill acquisition and learning in interventional radiology, there is still a lack of studies evaluating and standardizing the employment of this technology in relation to the numerous procedures that exist within the field of expertise.

More than 18 million people in 188 countries have been diagnosed as having coronavirus disease (COVID-19), and COVID-19 has been responsible for more than 600,000 deaths worldwide. Brazil is now the second most affected country globally. Faced with this scenario, various public health measures and changes in the daily routines of hospitals were implemented to stop the pandemic. Patients with hepatocellular carcinoma (HCC) are at an increased risk for severe COVID-19 as they present with two major diseases: cancer and concomitant chronic liver disease. The COVID-19 pandemic can significantly impact the management of HCC patients from diagnosis to treatment strategies. These patients need special attention and assistance at this time, especially since treatment for tumors cannot be delayed in most cases. The aim of this guideline was to standardize the management of HCC patients during the COVID-19 pandemic. This document was developed, on the basis of the best evidence available, by a multidisciplinary team from Instituto do Câncer do Estado de São Paulo (ICESP), and Instituto Central of the Hospital das Clínicas da Universidade de São Paulo (HC-FMUSP), which are members of the São Paulo Clínicas Liver Cancer Group.

ABSTRACT Objective To evaluate the effectiveness and outcomes of endovascular treatment of TRAS with PTA. Materials and Methods We searched our prospectively collected database looking at cases of TRAS between January 2005-December 2011. CCT was the gold-standart for diagnosis of TRAS. Parameters analysed comprised technical aspects, arterial blood pressure variation, and renal function. A minimum follow-up of 24 months was considered. Results Of the 2221 renal transplants performed in the selected period, 22 (0.9%) patients were identified with TRAS. Fourteen (63.6%) were male and mean age was 377±14.8years (12-69). Kidney graft was from deceased donnors in 20 (80%) cases. On doppler evaluation, mean blood flow speed after transplantation, at TRAS diagnosis and after TAP was 210.6±99.5, 417±122.7 and 182.5±81.6mL/sec, respectively (p<0.001). For SBP and DBP, there was a significant difference between between pre-intervention and all post-treatment time points (p<0.001). After 1 month of the procedure, there was stabilization of the Cr level with a significant difference between mean Cr levels along time (p<0.001). After a mean follow-up of 16±4.2 (3-24) months, overall success rate was 100%. Conclusions Endovascular treatment with PTA/stenting is a safe and effective option for managing TRAS, ensuring the functionality of the graft and normalization of blood pressure and renal function.

O acesso totalmente percutâneo para o implante de endopróteses aórticas, através da preclose technique, é possível mesmo quando utilizadas bainhas introdutoras de elevado perfil. Relatamos sete casos de tratamento endovascular de doenças da aorta, todos realizados de modo percutâneo, e discutimos os principais aspectos desta técnica.

Total percutaneous access for aortic endograft delivery, using the preclose technique, is feasible even with the use of large-diameter introducer sheaths. We report seven cases of percutaneous approach in endovascular treatment of aortic diseases and discuss the main technical aspects.

OBJETIVOS: Avaliar a utilidade da varfarina na prevenção dessas complicações nos pacientes de alto risco. MÉTODOS: Estudo clínico prospectivo, randomizado, cego, em pacientes submetidos ao primeiro implante transvenoso de DCEI, com FEVE<0,40 e/ou MPT ipsilateral ao implante definitivo. Após o procedimento, os pacientes foram randomizados para o uso diário de placebo ou varfarina. Avaliações clínicas e laboratoriais foram realizadas periodicamente. A pesquisa de obstruções venosas foi feita pela venografia por subtração digital, seis meses após o implante. De fevereiro de 2004 a novembro de 2006, foram selecionados 101 pacientes, havendo homogeneidade das características clínicas e operatórias de ambos os grupos (P=NS). RESULTADOS: No grupo Varfarina, 31,4% dos pacientes apresentaram obstruções venosas em comparação a 57,1% do grupo Placebo (RR= 0,57; IC 95%= 0,33 a 0,98; P= 0,015). No grupo Varfarina, 72% dos exames de INR realizados encontraram-se em nível terapêutico. Houve um caso de sangramento gastrintestinal, que justificou a interrupção do uso da varfarina e mudança para o grupo Placebo. CONCLUSÃO: Os resultados preliminares mostraram que o uso profilático da anticoagulação mostrou-se seguro e reduziu significativamente a incidência de obstruções venosas pós-implante de DCEI nos pacientes de alto risco.

OBJECTIVES: To evaluate the efficacy of prophylactic use of warfarin in patients with high risk of lead-associated thrombosis. METHODS: Clinical, prospective, randomized and blinded study, in patients submitted to first transvenous leads implantation with LVEF <0.40 and/or previous ipsilateral temporary pacing. After device implantation, patients were randomly assigned to placebo or warfarin. Periodical clinical and laboratorial evaluations were performed to anticoagulant management. After a six-month period, every patient was submitted to a digital subtraction venography. From February 2004 to November 2006, 101 patients underwent randomization. Baseline characteristics were similar in both groups (P=NS). RESULTS: Venographic analysis showed 31.4% of venous obstructions in patients assigned to warfarin as compared with 57.1% in patients assigned to placebo (RR= 0.57 [95% CI, 0.33 to 0.98]; P=0.015). In the warfarin group, 72% of the PT/INR tests were in therapeutic INR range. Only one patient required warfarin discontinuation and cross-over to placebo group due to gastrointestinal bleeding. CONCLUSIONS: These preliminary results showed that the anticoagulation therapy has been safe and reduced the frequency of venous thrombosis after transvenous cardiac devices implantation in high risk patients.

OBJETIVO: Estudar as alterações hemodinâmicas consideradas normais após a realização da anastomose portossistêmica intra-hepática transjugular (TIPS) e a eficácia dos parâmetros sugestivos de estenose do TIPS com o ultra-som Doppler. MATERIAIS E MÉTODOS: Dezesseis pacientes foram avaliados de maneira prospectiva, no período de dezembro de 2001 a março de 2003. As avaliações foram realizadas 24-48 horas após o TIPS e a seguir em intervalos regulares de 30 dias, três meses, seis meses e um ano, com ultra-som modo B, Doppler pulsado, Doppler colorido e de amplitude em diferentes pontos da prótese relacionados ao TIPS. A angiografia foi realizada apenas para a confirmação dos resultados e terapêutica pertinente. RESULTADOS: Até o momento apenas os achados de fluxo contínuo no terço proximal da prótese e o gradiente de velocidade entre dois pontos da prótese apresentaram significância estatística para o diagnóstico de estenose do TIPS (p < 0,001), mas outros diferentes critérios também estiveram presentes, porém sem significância estatística. CONCLUSÃO: O ultra-som Doppler é uma ferramenta eficaz no diagnóstico da perviedade e das complicações secundárias à realização do TIPS, sobretudo da estenose. No entanto, é necessária casuística maior, a fim de determinar um conjunto de parâmetros que facilite o seguimento destes pacientes, reservando a angiografia apenas para o tratamento pertinente.

OBJECTIVE: To assess the hemodynamic changes considered normal after transjugular intrahepatic porto-systemic shunt (TIPS) placement and the efficacy of TIPS parameters suggestive of stenosis using Doppler sonography. MATERIALS AND METHODS: Sixteen patients were prospectively evaluated from December, 2001 to March, 2003 after TIPS placement. Evaluations were performed 24 to 48 hours after the procedure and then at intervals of 30 days, three months, six months and one year using B mode, color Doppler, power Doppler and spectral Doppler in different TIPS related sites. Angiography was performed only to confirm Doppler findings and treatment. RESULTS: To date the only statistically significant parameters for diagnosis of TIPS stenosis were continuous flow pattern in the proximal third of TIPS and the velocity gradient between the two sites (p < 0.001). Different non-statistically significant parameters were also observed. CONCLUSION: Doppler sonography is an efficient tool for the diagnosis of shunt patency and TIPS related complications such as stenosis. However, it is necessary to study a larger number of patients in order to determine a group of parameters that would help in the follow-up of these patients, thus using portal angiography only for indicated treatment.

As malformações arteriovenosas do útero são entidades raras. Sua forma de apresentação clínica é muito diversa, devendo o ginecologista e o imaginologista estar atentos para esta possibilidade diagnóstica, para estabelecer o tratamento de forma precisa e rápida. O presente artigo visa mostrar um caso de malformação arteriovenosa uterina adquirida após doença trofoblástica gestacional, cujo diagnóstico foi bem estabelecido por meio da ultra-sonografia com Doppler colorido e correlação com angiorressonância magnética.

Uterine arteriovenous malformations are rare and the clinical features quite variable. Gynecologists and radiologists must be aware of this diagnostic possibility in order to indicate a fast and accurate treatment. The aim of the present paper is to present a case of uterine arteriovenous malformation acquired after trophoblastic gestational disease for which diagnosis was well established by means of color Doppler ultrasonography and correlation to magnetic angioresonance.