ABSTRACT Objective We aimed to share our experience in implementing a structured system for COVID-19 lung findings, elucidating key aspects of the lung ultrasound score to facilitate its standardized clinical use beyond the pandemic scenario. Methods Using a scoring system to classify the extent of lung involvement, we retrospectively analyzed the ultrasound reports performed in our institution according to COVID-RADS standardization. Results The study included 69 thoracic ultrasound exams, with 27 following the protocol. The majority of patients were female (52%), with ages ranging from 1 to 96 years and an average of 56 years. Classification according to COVID-RADS was as follows: 11.1% in category 0, 37% in category 1, 44.4% in category 2, and 7.4% in category 3. Ground-glass opacities on tomography correlated with higher COVID-RADS scores (categories 2 and 3) in 82% of cases. Ventilatory assessment revealed that 50% of cases in higher COVID-RADS categories (2 and 3) required second-line oxygen supplementation, while none of the cases in lower categories (0 and 1) utilized this support. Conclusion Lung ultrasound has been widely utilized as a diagnostic tool owing to its availability and simplicity of application. In the context of the pandemic emergency, a pressing need for a focused and easily applicable assessment arose. The structured reporting system, incorporating ultrasound findings for stratification, demonstrated ease of replicability. This system stands as a crucial tool for screening, predicting severity, and aiding in medical decisions, even in a non-pandemic context. COVID19 COVID 19 COVID-1 scenario involvement COVIDRADS RADS standardization 6 exams protocol 52%, 52 52% , (52%) 9 5 follows 111 11 11.1 0 37 444 44 4 44.4 74 7 7.4 3 Groundglass Ground glass 82 50 ( secondline second line supplementation support application emergency arose stratification replicability screening severity decisions nonpandemic non COVID1 COVID- (52% 11. 44. 7. 8 (52 (5

ABSTRACT Objective: To describe angiographic findings of the superior rectal artery, its branches, and anatomical variations in the hemorrhoidal plexus in patients undergoing rectal artery embolization for hemorrhoidal disease treatment. Methods: Angiographic findings of 15 patients were obtained from a single-center, prospective clinical study that compared superior rectal artery embolization with the Ferguson technique for hemorrhoidal disease between July 2018 and March 2020. Results: Angiography of the superior rectal artery showed that in seven patients (46.8%), its branches were divided into four main branches (two left and two right), while in four patients (26.6%), the branches divided into one right and two left branches. The most uncommon variation observed in three cases (20%) was the branches divided into two branches to the right and one to the left; no further subdivision into the main branches was observed in one case (6.6%). Conclusion: Four patterns were observed in the angiographic anatomy of the superior rectal arteries. Knowledge of the angiographic anatomy of this region and its variations is essential to improve the effectiveness of superior rectal artery embolization. Registry of Clinical Trials: NCT03402282 Objective treatment Methods 1 singlecenter, singlecenter single center, center single-center 201 2020 Results 46.8%, 468 46.8% , 46 8 (46.8%) right, right) 26.6%, 266 26.6% 26 6 (26.6%) 20% 20 (20% 6.6%. 66 6.6% . (6.6%) Conclusion arteries Trials NCT NCT0340228 202 46.8 4 (46.8% 26.6 2 (26.6% (20 6.6 (6.6% NCT034022 46. (46.8 26. (26.6 (2 6. (6.6 NCT03402 (46. (26. ( (6. NCT0340 (46 (26 (6 NCT034 (4 NCT03 NCT0

ABSTRACT Objective: This study assessed the cost-effectiveness of radiofrequency ablation compared with percutaneous ethanol injection in patients with early hepatocellular carcinoma in relation to the objective response rate and costs related to the procedure. Methods: This was a prospective single-center randomized trial. The primary outcome was cost-effectiveness. Secondary outcomes were the complete response rate according to the modified response evaluation criteria in solid tumors 60 days after randomization and the complication rate within 180 60 days. Results: Fifty patients were placed into the following groups: percutaneous ethanol injection (n=23) and radiofrequency ablation (n=27). Fifty-four nodules were randomized (mean follow-up: 205.37 days). The estimated mean hospital cost was US$ 1854.11 and US$ 2770.96 for the Radiofrequency Ablation and Percutaneous Ethanol Injection Groups, respectively. The incremental cost-effectiveness ratio was US$ -2674.59, which is advantageous for radiofrequency ablation. After 60 d, 28 of 29 nodules in the Radiofrequency Ablation Group achieved complete response versus 12 of 22 in the Percutaneous Ethanol Injection Group (RD, 42.01 [95%CI= 20.55–63.24]; p<0.001). Only four early complications were observed among patients treated by percutaneous ethanol injection (p<0.05). Late complications occurred in two and one patient(s) in the Radiofrequency Ablation and Percutaneous Ethanol Injection Groups (p>0.05), respectively. Conclusion: Radiofrequency ablation was more cost-effective and achieved higher complete response and lower complication rates than the Percutaneous Ethanol Injection Group within this cohort. Registry of Clinical Trials: NCT06450613 Objective costeffectiveness effectiveness procedure Methods singlecenter single center trial costeffectiveness. effectiveness. 6 18 Results groups n=23 n23 n 23 (n=23 n=27. n27 n=27 . 27 (n=27) Fiftyfour followup follow up follow-up 20537 205 37 205.3 days) US 185411 1854 11 1854.1 277096 2770 96 2770.9 respectively 2674.59, 267459 2674 59 -2674.59 d 2 1 RD, RD (RD 4201 42 01 42.0 95%CI= 95CI CI 95 [95%CI 20.55–63.24 20556324 20 55 63 24 20.55–63.24] p<0.001. p0001 p p<0.001 0 001 p<0.001) p<0.05. p005 p<0.05 05 (p<0.05) patient s patient(s p>0.05, p>0.05 , (p>0.05) Conclusion costeffective effective cohort Trials NCT NCT0645061 n=2 n2 (n=2 (n=27 2053 3 205. 18541 185 1854. 27709 277 9 2770. 2674.59 26745 267 5 -2674.5 420 4 42. 95%CI 20.55–63.2 2055632 p000 p<0.00 00 p00 p<0.0 (p<0.05 p>0.0 (p>0.05 NCT064506 n= (n= 2674.5 26 -2674. 20.55–63. 205563 p0 p<0. (p<0.0 p>0. (p>0.0 NCT06450 (n 2674. -2674 20.55–63 20556 p<0 (p<0. p>0 (p>0. NCT0645 -267 20.55–6 2055 p< (p<0 p> (p>0 NCT064 -26 20.55– (p< (p> NCT06 -2 20.55 (p NCT0 - 20.5 20.

ABSTRACT Radical treatment for prostate cancer is associated with significant morbidity. Percutaneous image-guided irreversible electroporation is a non-thermal ablative technique that has emerged as a valuable option. This study describes the case of a patient with prostate cancer who was successfully treated using irreversible electroporation. We report the case of a 72-year-old male patient who presented with elevated PSA (4.0ng/mL) during routine testing. Multiparametric magnetic resonance imaging of the prostate revealed a 0.8 cm lesion in the posterolateral aspect of the right midgland with marked hypointensity on ADC (ACR PI-RADS 4). The transperineal prostate revealed acinar adenocarcinoma (Gleason Score 3+3=6; International Society of Urological Pathology=1). Serum PSA levels reduced to 1.04ng/mL 32 days after the procedure and remained within normal limits (1.26ng/mL) after 349 days. Follow-up imaging performed 90 days later with prostate-specific membrane antigen PET/MRI showed size reduction, retraction, and diffuse hypointensity in the peripheral zone of the right prostate lobe, with no increase in prostate-specific membrane antigen uptake. Magnetic resonance imaging found no suspicious lesions 367 days after irreversible electroporation. At the final clinical follow-up at 390 days, the patient was asymptomatic. Our findings illustrate the potential of irreversible electroporation as a possible alternative treatment for prostate cancer. morbidity imageguided image guided nonthermal non thermal option 72yearold yearold 72 year old 4.0ng/mL 40ngmL ngmL 4 0ng mL ng (4.0ng/mL testing 08 0 8 0. ACR PIRADS PI RADS 4. . 4) Gleason 3+3=6 336 3 6 Pathology=1. Pathology1 Pathology Pathology=1 1 Pathology=1) 104ngmL 04ng 1.26ng/mL 126ngmL 26ng (1.26ng/mL 34 Followup Follow up 9 prostatespecific specific PETMRI PET MRI reduction retraction lobe uptake 36 followup follow 39 asymptomatic 7 3+3= 33 Pathology= 3+3 3+

ABSTRACT Purpose To analyze the learning curve regarding complication rates of transrectal prostate biopsy (TRPB) versus transperineal prostate biopsy (TPPB), using real time software-based magnetic resonance imaging ultrasound (MRI-US) fusion techniques, along with first year experience of transperineal approach. Materials and Methods retrospective unicentric cohort study at a quaternary care hospital. Medical records of all consecutive patients that underwent TPPB between March 2021 and February 2022, after the introduction of MRI-US fusion device, and those who underwent TRPB throughout the entire years of 2019 and 2020 were analyzed. All complications that occurred as consequences of the procedure were considered. Descriptive statistics, Chi-squared and Fisher tests were used to describe complications and compare the two groups. Results A total of 283 patients were included in the transperineal group and 513 in the transrectal group. The analysis of a learning curve for the transperineal method showed lower complications rates comparing the first six months of TPPB procedures (group 1); The complication rate for TPPB was lower than that of TRPB (55.1% versus 81.9%, respectively; p<0.01). TPPB showed specifically lower rates of hematuria (48.8% versus 66.3%;p<0.001) and rectal bleeding(3.5% versus 18.1%; p<0.001). There were no cases of prostatitis after transperineal biopsies and three cases (0.6%) after transrectal procedures. Conclusions We evidenced the learning curve for performing the transperineal biopsy, with a lower rate of complications for the experienced team, after 142 cases after 6 months of practice. The lower complication rate of TPPB and the absence of infectious prostatitis imply a safer procedure when compared to TRPB. (TRPB TPPB, , (TPPB) softwarebased software based MRIUS MRI US (MRI-US techniques approach hospital 202 2022 device 201 analyzed considered statistics Chisquared Chi squared groups 28 51 1 1) 55.1% 551 55 (55.1 819 81 9 81.9% respectively p<0.01. p001 p p<0.01 . 0 01 p<0.01) 48.8% 488 48 8 (48.8 66.3%p<0.001 663p0001 66.3% p<0.001 66 3 001 66.3%;p<0.001 bleeding3.5% bleeding35 bleeding 3.5% 5 bleeding(3.5 18.1% 181 18 p<0.001. p0001 p<0.001) 0.6% 06 (0.6% team 14 practice (TPPB 20 2 55.1 (55. 81.9 p00 p<0.0 48.8 4 (48. 66.3%p<0.00 663p000 663 66.3 p<0.00 00 66.3%;p<0.00 bleeding3 bleeding3.5 35 3.5 bleeding(3. 18.1 p000 0.6 (0.6 55. (55 81. p0 p<0. 48. (48 66.3%p<0.0 663p00 66. 66.3%;p<0.0 bleeding3. 3. bleeding(3 18. 0. (0. (5 p<0 (4 66.3%p<0. 663p0 66.3%;p<0. bleeding( (0 ( p< 66.3%p<0 663p 66.3%;p<0 66.3%p< 66.3%;p< 66.3%p 66.3%;p

ABSTRACT Pulmonary aspiration of gastric residues during anesthesia is a potentially fatal complication for which no specific treatment is available. The primary way to prevent its occurrence in the context of elective surgeries is adherence to fasting protocols. However, some clinical conditions can prolong the gastric emptying time, and the risk of aspiration may exist despite adequate fasting. Recognizing the risk factors for gastroparesis allows the adoption of preventive methods and is the primary way to reduce morbidity and mortality from pulmonary aspiration. In this scenario, the anesthesiologist can investigate the gastric content by using ultrasound, adjust the anesthetic technique, and even postpone elective surgeries. Here, we describe incidental computed tomography finding of solid contents in the stomach of a patient without prior identification of the risk factors for gastroparesis. The patient underwent elective renal nodule ablation under general anesthesia after fasting for 9 hours. During the procedure, solid contents in the stomach were noted on computed tomography. Subsequently, it was discovered that the patient had been using semaglutide for 6 days and had not disclosed this information. Semaglutide use may represent a new and significant risk factor for anesthesia-related pulmonary aspiration. Until studies provide information on the appropriate perioperative management of patients using semaglutide, anesthesiologists need to adopt preventive measures to avoid aspiration. Awareness of this potential association and open communication among patients, physicians, and anesthesia teams are essential for enhancing patient safety. available protocols However time scenario ultrasound technique Here hours procedure Subsequently anesthesiarelated related physicians safety

ABSTRACT Objective To describe the clinical, bronchoscopic, diagnostic, and therapeutic aspects between children and adults. Methods This retrospective study compared the clinical and bronchoscopic characteristics of adults and children who underwent bronchoscopy for suspected foreign body aspiration. Data on sex, outpatient or emergency origin, bronchoscopy results, characteristics of the aspirated foreign body, and complications were analyzed. Results In total, 108 patients were included in the analysis, with foreign body aspiration diagnosed in 69% of patients (30 children and 44 adults). In 91% of patients, there was a clinical history suggestive of aspiration. The mean age of the adults was 65.89 (±19.75) years, and that of the children was 2.28 (±1.78) years. Most of the children were under 3 years of age (80%), while adults were mostly 70 years of age or older (54.5%). Emergency care was more common among children than adults. The most common foreign bodies found in both age groups were organic bodies, primarily seeds. The most frequent locations of foreign bodies were the lobar bronchi in adults and the main bronchi in children. Flexible bronchoscopy is the primary method for diagnosis and treatment. Transient hypoxemia occurred particularly frequently in children (5%). Conclusion Foreign body aspiration, particularly that involving seeds, is more common in the extremes of age. A clinical history suggestive of aspiration is crucial in determining the need for bronchoscopy, which should be performed as early as possible. Flexible bronchoscopy is an effective and safe diagnostic technique. sex origin results analyzed total 10 analysis 69 30 (3 4 . adults) 91 6589 65 89 65.8 ±19.75 1975 19 75 (±19.75 228 2 28 2.2 ±1.78 178 1 78 (±1.78 80%, 80 80% , (80%) 7 54.5%. 545 54.5% 54 5 (54.5%) seeds treatment 5%. 5% (5%) possible technique 6 ( 9 658 8 65. ±19.7 197 (±19.7 22 2. ±1.7 17 (±1.7 (80% 54.5 (54.5% (5% ±19. (±19. ±1. (±1. (80 54. (54.5 (5 ±19 (±19 ±1 (±1 (8 (54. ± (± (54

Resumo Este estudo objetiva descrever uma série de casos de pacientes submetidos a embolização do ducto torácico (EDT) para tratamento de quilotórax iatrogênico (QI). Três pacientes foram incluídos. Caso 1: um homem de 49 anos com linfoma folicular apresentou QI após ressecção de uma massa paravertebral por toracoscopia vídeo-assistida e foi submetido a EDT com micromolas e n-butil-cianoacrilato (NBCA). Caso 2: um homem de 68 anos com amiloidose cardíaca apresentou QI após ser submetido a transplante cardíaco e foi submetido a EDT com micromolas e copolímero de etileno e álcool vinílico. Caso 3: um paciente de 6 anos com malformação cardíaca congênita apresentou QI após cirurgia de Fontan e foi submetido a EDT com NBCA. Todas as lesões foram identificadas durante a linfangiografia, e a EDT foi realizada com sucesso. A EDT é uma técnica segura e valiosa, que pode oferecer um tratamento minimamente invasivo em casos de QI. (EDT . (QI) incluídos 1 4 vídeoassistida vídeo assistida nbutilcianoacrilato n butil cianoacrilato NBCA (NBCA) 2 vinílico 3 linfangiografia sucesso valiosa (QI (NBCA

Abstract This study aims to describe a case series of patients who underwent thoracic duct embolization (TDE) to treat traumatic iatrogenic chylothorax (TIC). Three patients were included: Case #1, a 49-year-old woman with follicular lymphoma developed a TIC following video-assisted thoracoscopic surgery to resect a solid right paravertebral mass and was treated with TDE using microcoils and N-butyl cyanoacrylate (NBCA) glue. Case #2, a 68-year-old man with cardiac amyloidosis developed a TIC following heart transplantation and was treated with TDE using microcoils and ethylene vinyl alcohol copolymer. Case#3: A 6-year-old patient with congenital heart disease developed a TIC following a Fontan procedure and was treated with TDE using NBCA glue. All lesions were identified during lymphangiography and TDE was successfully performed in all cases. TDE is a safe and valuable technique that provides minimally invasive treatment for TCI. (TDE TIC. . (TIC) included 1 #1 49yearold yearold 49 year old videoassisted video assisted Nbutyl N butyl (NBCA glue 2 #2 68yearold 68 copolymer Case#3 Case3 3 6yearold 6 cases TCI (TIC # 4 Case#

ABSTRACT Objective To describe the radiological characteristics of hepatocellular carcinoma (HCC) lesions that achieved a complete response following drug-eluting bead transarterial chemoembolization (DEB-TACE) preceding liver transplantation. Methods This single-center case-control study enrolled patients with hepatocellular carcinoma who underwent neoadjuvant DEB-TACE therapy, were followed up with contrast-enhanced magnetic resonance imaging or computed tomography, and were successively evaluated according to the modified Response Evaluation Criteria in Solid Tumors. The HCCs were divided into two groups based on their diameter (Group A: ≤3cm; Group B: 3cm). Viability was assessed using the Kaplan-Meier method according to tumor size categories. The relationship between tumor variables was analyzed using bivariate Cox regression. Results Three-hundred and twenty-eight patients with 667 hepatocellular carcinomas who underwent their first DEB-TACE session were enrolled. A total of 105 hepatocellular carcinomas in 59 patients exhibited complete response after the initial DEB-TACE session and were divided into Group A (92 HCCs) and Group B (13 HCCs). The diameter in Group A decreased significantly compared to the pre-procedure size until the second assessment (p<0.001), with no subsequent reduction in diameter, despite maintaining a complete response. In Group B, the reduction in diameter remained significant compared with the initial value until the sixth imaging evaluation (p=0.014). The average reduction was 45.1% for Group B and a maximum of 14.9% in Group A. Conclusion HCCs >3cm exhibited a greater reduction in size and a longer time to recurrence. HCCs ≤3cm had a shorter relapse time. The recurrence rates were similar. These findings may aid in planning for liver transplantation. HCC (HCC drugeluting drug eluting DEBTACE DEB TACE (DEB-TACE transplantation singlecenter single center casecontrol case control therapy contrastenhanced contrast enhanced tomography Tumors 3cm cm 3cm. . 3cm) KaplanMeier Kaplan Meier categories regression Threehundred Three hundred twentyeight twenty eight 66 10 5 92 (9 13 (1 HCCs. preprocedure pre procedure p<0.001, p0001 p p<0.001 , 0 001 (p<0.001) p=0.014. p0014 p=0.014 014 (p=0.014) 451 45 1 45.1 149 14 9 14.9 similar 6 ( p000 p<0.00 00 (p<0.001 p001 p=0.01 01 (p=0.014 4 45. 14. p00 p<0.0 (p<0.00 p=0.0 (p=0.01 p0 p<0. (p<0.0 p=0. (p=0.0 p<0 (p<0. p=0 (p=0. p< (p<0 p= (p=0 (p< (p= (p

Resumo Um paciente de 100 anos foi diagnosticado com um aneurisma de aorta abdominal roto por um endoleak 1A. Pela proximidade do ponto de ruptura com a artéria mesentérica superior (AMS) e as artérias renais, um ChEVAR foi indicado. A cateterização das artérias-alvo foi um passo desafiador pela intensa tortuosidade da aorta torácica. Essa anatomia aórtica hostil também impediu a troca por um fio-guia extra-rígido, e a cateterização seletiva foi repetidamente perdida quando a troca de fio-guia foi tentada. Para superar essa dificuldade, um cateter balão 5mm x 40mm foi posicionado nas artérias-alvo. O balão foi, então, insuflado abaixo da pressão nominal, permitindo uma troca segura do fio-guia por um fio-guia extra-rígido e o posicionamento de três bainhas longas 7Frx 90cm. Assim, o procedimento foi executado de forma segura, com o implante de uma extensão aórtica e dos stents recobertos. 10 1A AMS (AMS renais indicado artériasalvo alvo torácica fioguia fio guia extrarígido, extrarígido extra rígido, rígido tentada dificuldade mm artériasalvo. alvo. então nominal Frx 90cm cm Assim recobertos 1

Abstract A 100-year-old male patient was admitted with a ruptured abdominal aortic aneurysm due to type IA endoleak. Given the proximity of the ruptured site to the superior mesenteric artery (SMA) and renal arteries, a ChEVAR was indicated. Catheterization of the target visceral vessels was a challenging procedural step because of an intensely tortuous thoracic aorta. This hostile aortic anatomy also inhibited exchange for a super stiff guide-wire and selective cannulation with the diagnostic catheter was repeatedly lost when guidewire exchange was attempted. To overcome this issue, a 5 x 40 mm balloon catheter was placed 3cm into the target arteries. The balloon was then inflated below the nominal pressure limit enabling safe exchange for a super stiff guidewire and placement of three 90-cm long 7Fr guiding sheaths. The procedure was thus safely performed with deployment of an aortic extension and the bridging stents. 100yearold yearold 100 year old endoleak SMA (SMA arteries indicated aorta guide wire attempted issue 4 cm 90cm 90 Fr sheaths stents 10 9 1

ABSTRACT Lymphoceles are collections of lymphatic fluid, mainly caused by major surgical approaches. Most lymphoceles are asymptomatic and limited, but some cases may require a medical management. Among the different techniques, transafferent nodal embolization has emerged as a minimally invasive option, with low morbidity and high resolubility, although it is not widespread in the Brazilian scenario. In this study, we report a case of lymphocele drained percutaneously, with maintenance of high output and requiring transafferent nodal embolization.

ABSTRACT A 2-year-old female patient, admitted in the emergency room, presented diarrhea for 5 days and bloody stools in the last 24 hours. Physical examination revealed no significant findings. Ultrasound was initially performed, showing an elongated, well delimited and solid mass occupying since right hypocondrium until left iliac fossa, displacing adjacent structures. In sequence, magnetic resonance imaging was performed for confirmation of findings suggestive of omentum lipoma. After 1 week, the surgical resection was performed by videolaparoscopic acess. During 2-year follow-up, there was no sign of recurrence.