Transthoracic Biopsy is a complementary diagnostic test used to diagnose lung, pleural and mediastinal injuries. This procedure, performed through puncture with intermittent support of axial images, or with Fluro-CT, in which the control of the needle position is done in real time, according to a minimally invasive method, can be performed in an outpatient setting. The type and size of the needle to be selected is done according to the type of biopsy to be performed (cytology or histology). This means of diagnosis can be influenced by factors inherent to the patient, experience of the executing physician, type of needle, etc. The objective of this project is to analyze the complications of transthoracic biopsies in patients enrolled at the Portuguese Institute of Oncology in Oporto and who will be subjected to this procedure, in order to clarify and establish the reality of the Radiology Intervention Service.

Image-guided breast biopsy is an effective method for the diagnosis of breast cancer, although it has been described the occurrence of complications. Objective: To quantify the prevalence of breast biopsies complications occurred in the Breast Imaging of the Portuguese Institute of Oncology of Porto during 2017. Results: In a total of 6.9% (95%CI: 5.5%−8.6%) and 1.9% (95%CI: 1.2%−2.8%) of the 1180 breast biopsies performed occurred at least one immediate (during the procedure or until the patient leaves the service) or late (after the participant leaves the service and up to 30 days after) complications, respectively. The most frequent immediate and late complications were pain and the presence of inflammatory signs at the biopsy site, respectively. Conclusion: The complications of breast biopsies were an uncommon event, affecting 7 out of 100 participants in the immediate and about 2 out of 100 participants up to 30 days after its execution.

Introduction: Endovascular aneurysm repair (EVAR) has expanded into progressively more challenging anatomies. Proximal neck-morphology represents the major determinant of EVAR durability. Neck-diameter constitutes one of the most important anatomical neck features and influence proximal sealing over time.The purpose of this study is to investigate the influence of wide proximal necks on outcome after standard EVAR. Methods: MEDLINE databases were searched to identify publications addressing the relation between aortic neck diameter and incidence of AAA-related complications. Results: Six studies were included in our review, addressing 6602 patients: 1616 with large necks and 4986 with small necks. Five studies, including 6446 patients, reported higher rates of type 1A endoleak in patients with large necks with hazard/ odds ratios ranging between 2.3–4.1. One study found a higher risk of post-implant rupture in patients with necks>30mm (HR: 5.1; 95% CI, 1.4–19.2). Four studies reported on the influence of wide necks on AAA-related mortality without finding any association. Reduced overall survival was seen in patients with large necks in 4 studies (long term survival ranged between 61.6 and 68% for wide neck patients and 75–90 % for small neck patients), mostly attributable to cardiovascular causes. Conclusions: Patients with wide proximal necks are at greater risk for type 1A endoleak, post-implant rupture and overall-mor- tality. This subgroup of patients may be considered for more complex proximal seal strategies with fenestrated/branched devices or open repair, although there is no evidence of superiority of alternative strategies to standard EVAR in large necks.This subgroup should be offered more stringent imaging follow-up and aggressive treatment of medical comorbidities.

Introduction:  A number of guidelines for the management of carotid disease are available to help clinicians in therapeutic decision and provide useful guidance for the best care of the patients. They stated that carotid endarterectomy (CEA) has some benefit in symptomatic patients with carotid stenosis of 50-69% and is highly beneficial in stenosis of 70-99%, with mortality/ stroke rate less than 6%. The maximum benefit is observed when surgery is performed within two weeks after the cerebrovascular event. CEA in asymptomatic patients should be offered to patients with life expectancy higher than 5 years, stenosis of >70%, and perioperative complications should be less than 3%. The aim of this study is to analyse our clinical practice, review treated patients and referral times and compare the outcomes of our institutional practice with published guidelines. Material and methods: Retrospective study of patients undergoing carotid endarterectomy at Centro Hospitalar Universitário do Porto between 2010 and 2015. Results: Between 2010 and 2015, 404 patients underwent CEA, 76% men, and mean age 69 years for both sexes. The degree of stenosis was usually evaluated by ultrasound. The use of complementary study with angio-CT was required in 20% and angiography in 2.2% of the cases. The majority of patients (54.2%) were symptomatic (stroke/ TIA <6 months). In patients with a cerebrovascular event diagnosed at our institution, the time to surgery was 10 days (median). All CEA were performed under general anaesthesia and for arterial closure, a Dacron patch was systematically used. Shunt was used in 4.6% of cases (n=18). The mean surgery time was 101 minutes and the mean clamping time was 40 minutes. Reversal of antioagulation with protamine was performed in 48.3% patients. Morbimortality: 9 post-operative sequelae events (major stroke), 8 minimal / transient deficit (minor stroke) and 4 deaths. In symptomatic patients (n = 219), the rate of postoperative major stroke was 3.6%. In asymptomatic patients (n = 185), a major and a minor stroke was observed (1.1%). Other complications: haematoma 5.9% (n=24); infection 0.2% (n=1); peripheral nerve dysfunction 8.7% (n=35); false aneurysm 0.5% (n=2). Conclusions: Our results are within the reference values. This study allowed us to know our reality, our ability to give an effective answer for our patients, and to serve as a basis for improving ways of acting.

Introduction: Nellix® endoprosthesis (Endologix Inc., Irvine, CA) is composed by two ballon-expandable stents surrounded by endobags, which are filled with a polymer, thus obliterating the aneurysmal sac – Endovascular Aneurysm Sealing (EVAS). Initially, due to its properties, was introduced with extended IFU, allowing the use in more complex abdominal aortic aneurysms. However, during the initial experience with this endoprosthesis, a high number of poor outcomes have been described, leading to the progressive restriction of IFU. Currently, it has been discontinued and is only available in selected centers for clinical research purposes. Our study aim to report the institutional results of the use of the Nellix® endoprosthesis in the treatment of AAA. Material and Methods: A retrospective study was designed, including patients with AAA treated with Nellix® endoprosthesis treated at a universitary tertiary care facility. Elective and urgent patients we're included, and patients we're identified through the institutional files. Thoraco-abdominal aneurysm we're excluded. Data about baseline characteristics, surgery, hospitalization course and follow-up post discharge was obtained by consulting personal clinical files. Primary endpoints are technical and clinical success at 30 days, as complications and secondary interventions at mid and long-term. Results: Between 2015 and 2017, this endoprosthesis was used in 12 patients, 9 male and 3 female, with a mean age of 71 (±8) years. The most common comorbidities associated we're hypertension (n=12), current or former tobacco use (n=7), coronary heart disease (n=7), peripheral artery disease (n=6) and chronic kidney disease (n=6) In all patients, the treatment indication was primary degenerative aneurysm, with one exception, which was the presence of type 1a EL after EVAR. Ten patients underwent elective and 2 urgent surgery due to symptomatic aneurysm. Three we're aortoiliac aneurysms and the remaining aortic aneurysms (n=9) with three having involvement of at least one renal artery. Nine patients underwent conventional EVAS; the remaining EVAS with chimney (ChEVAS) for the renal artery(ies) or superior mesenteric artery (n=3). The average preoperative diameter was 57(±6.5) mm. One patient was simultaneously submitted to endovascular repair of a popliteal artery aneurysm with covered stent. By 30 days, death occurred in 2 patients, all submitted to ChEVAS. The most common post-operative complications we're respiratory failure (n=3), AKI with dialysis (n=3), being that in two patients there was intentional covering of the renal arteries (patients with pre-dialysis CKD). In this time frame, we verified one reintervention: catheter-directed thrombolysis for acute limb ischemia due to popliteal covered stent thrombosis. After 30 days, 4 deaths occured (2 year survival 60%, SE 0.154). The most common complications were type 1a EL(n=3), type 1b EL(n=1) and aortic stent thrombosis (n=1). Two patients have already been reintervened: one submitted to femoro-femoral crossover bypass and the other to surgical endoprosthesis explantation and in situ reconstruction aortobifemoral bypass. The last was deceased in the early postoperative period. Two patients are waiting reintervention for type Ia EL and aneurysmal sac growth. The average sac diameter in last follow-up or before secondary intervention was 59(±10.6) mm. Mean follow-up time is 2,3(±1,6) years.  Conclusions: In our institution, the use of Nellix® endoprosthesis is associated with a high rate of perioperative morbidity and mid to long-term aneurysm-related complications, being type Ia EL the most common. Although the free use of the endoprosthesis is currently discontinued, patients who have previously undergone EVAS lack a specific and more intensive surveillance plan for the timely detection and correction of complications.

Os objetivos deste estudo foram estimar as prevalências das lesões nos tecidos moles, dos tipos de traumatismos nos dentes decíduos anteriores por faixa etária e das sequelas nos dentes decíduos traumatizados e em seus sucessores. Também se verificou a existência de associação entre as sequelas nos permanentes e os tipos de traumatismos nos antecessores, em relação a idade de crianças com 0-10 anos. Foram analisados 1230 prontuários de crianças, atendidas no Projeto de Extensão da Disciplina de Odontopediatria da Faculdade de Odontologia da Universidade do Estado do Rio de Janeiro (FOUERJ), no período de março de 1996 a dezembro de 2010. Os responsáveis assinaram o termo de Consentimento aprovado pelo Comitê do Hospital Universitário Pedro Ernesto (HUPE). As análises envolveram estatística descritiva e os testes χ2 e χ2 de Mantel-Haenszel. Foram selecionados 459 (37,3%) prontuários resultando em 764 dentes decíduos anteriores traumatizados. As lesões mais prevalentes dos tecidos moles foram as lacerações em gengiva (9,4%) seguidas pelas lacerações nos lábios (5,6%). A luxação intrusiva (27,8%) foi o tipo de traumatismo mais prevalente na faixa etária de 0-3 anos de idade (71,9%) seguida da avulsão (14,8%). As sequelas mais comuns nos decíduos foram a perda prematura (30,3%) e a alteração de cor do esmalte (26,9%). Nos sucessores, a alteração de cor (26,0%) e a hipoplasia de esmalte (24,5%) foram as sequelas mais prevalentes. O grupo de [0,1] ano de idade apresentou uma diferença significativa (p= 0,007) quando analisado isoladamente. Em uma segunda análise estatística houve diferença para a faixa etária de (5,10] (p=0,023). A laceração na gengiva foi o tipo de lesão mais prevalente. A luxação intrusiva foi o tipo de traumatismo mais prevalente na faixa etária de 0 a 3 anos. A perda prematura foi a sequela mais prevalente na dentição decídua enquanto na permanente predominou a alteração de cor. Houve associação na faixa etária de [0, 1] ano e a luxação intrusiva originou um maior número hipoplasia de esmalte. Também houve associação na faixa etária de (5-10] anos. A luxação intrusiva originou uma maior prevalência da alteração de erupção.

Introdução: A terapia nutricional enteral (TNE) é a via de escolha preferencial para nutrir pacientes graves e tem como principal objetivo prevenir e tratar as deficiências nutricionais e a desnutrição hospitalar. Atingir as metas energéticas e proteicas nestes pacientes é um desafio diário para a equipe de cuidados no ambiente da terapia intensiva. Objetivo: Monitorar a oferta energética e proteica e as inadequações da TNE em pacientes críticos internados em uma unidade de terapia intensiva. Método: Em um estudo longitudinal prospectivo, foram estudados 82 pacientes internados em uma unidade de terapia intensiva de um hospital universitário. Foram avaliadas as seguintes variáveis: metas energética e proteica da (TNE), os valores prescritos e administrados da (TNE), as causas e frequências das inadequações na infusão da dieta, e os desfechos da terapia nutricional. O diagnóstico nutricional foi definido por meio de parâmetros antropométricos, exames laboratoriais e instrumentos de rastreamento nutricional (nutric score e nutritional risk screening). Para a análise estatística foi utilizado o teste de Wilcoxon, o teste Qui-quadrado ou teste Exato de Fisher e o teste de Mann-Whitney. Resultados: A média da meta energética foi de 2.132,91 kcal e a proteica foi de 113,96 g por dia. A infusão média de energia foi de 53,44% da meta e de proteína foi de 43,72% da meta, diferença estatisticamente significante para ambas as variáveis (p<0,0001). Verificou-se diferença estatisticamente significante (p<0,0001) para todas as comparações efetuadas entre a meta, prescrição e infusão da TNEE. Para a caloria, a prescrição foi em média 68% (p<0,0001) do valor da meta calculada, sendo infundido 53% (p<0,0001) do valor da meta energética. Para a proteína, a prescrição foi em média 58% (p<0,0001) do valor da meta, sendo infundido em média 43% (p<0,0001) do valor da meta proteica. Foi infundido 72% do que foi prescrito tanto para caloria como para proteína. Todos os pacientes avaliados apresentaram algum tipo de intercorrência na infusão e para 90% dos pacientes não houve justificativa para o atraso na infusão. Cinquenta por cento (50%) dos pacientes em TNE apresentavam risco nutricional. Conclusão: A TNE não supre totalmente as necessidades energéticas e proteicas dos pacientes críticos. As complicações que acometem o paciente grave interrompem a infusão da dieta, bem como atrasos evitáveis. Tais achados reforçam a importância do monitoramento adequado e cuidadoso da terapia nutricional enteral no paciente grave.

The coronavirus disease (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread exponentially worldwide. In Brazil, the number of infected people diagnosed has been increasing and, as in other countries, it has been associated with a high risk of contamination in healthcare teams. For healthcare professionals, the full use of personal protective equipment (PPE) is mandatory, such as wearing surgical or filtering facepiece class 2 (FFP2) masks, waterproof aprons, gloves, and goggles, in addition to training in care processes. A reduction in the number of face-to-face visits and non-essential elective procedures is also recommended. However, surgery should not be postponed in the case of the most essential elective indications (mostly associated with head and neck cancers). As malignant tumors of the head and neck are clinically time sensitive, neither consultations for these tumors nor their treatment should be postponed. Postponing surgical treatment can result in a change in the disease stage and alter an individual’s chance of survival. In this situation, planning of all treatments must begin with the request for, in addition to routine examinations, a nasal swab polymerase chain reaction for SARS-CoV-2 and chest computed tomography. Only if the results of these tests are positive or if fever or other symptoms suggestive of COVID-19 are present should the surgical procedure be postponed until the patient completely recovers. This is mandatory not only because of the risk of contamination of the surgical team but also because of the increased risk of postoperative complications and high risk of death. During this pandemic, the most effective safety measures are social distancing for the general public and the adequate availability and use of PPE in the healthcare field. The treatment of other chronic diseases, such as cancer, should be continued, as the damming of cases of these diseases will have a deleterious effect on the public healthcare system.

OBJECTIVES: Craniofacial resection (CFR) procedures for craniofacial tumors with cranial extension are often extensive. Although CFRs may yield good oncological results, there are concerns about high perioperative morbidity and mortality. This study aimed to determine risk factors for perioperative mortality after open CFR in terms of deaths occurring during index hospitalizations. METHODS: We conducted a retrospective analysis of CFRs conducted at a tertiary oncology hospital from May 2009 through December 2018. RESULTS: Our analysis included data from the medical records of 102 patients, the majority of whom were male (n=74, 72.5%). The mean age was 61 years (±18.3 years). Skin malignancies (n=64, 63.4%) accounted for nearly two-thirds of the treated tumors, and most of these were squamous cell carcinoma. Postoperative medical complications occurred in 33 patients (33%), and surgical complications occurred in 48 (47%). Multivariate analysis revealed the only independent risk factors for perioperative deaths to be the presence of intracranial tumor extension on preoperative imaging (hazard ratio [HR]=4.56; 95% confidence interval [CI]: 1.74–11.97; p=0.002) and the unexpected emergence of postoperative neurological dysfunction (HR=10.9; 95% CI: 2.21– 54.3; p=0.003). CONCLUSIONS: In our study, factors related to tumor extension were associated with a higher risk of perioperative death.

OBJECTIVES: Although liver transplantation procedures are common and highly expensive, their cost structure is still poorly understood. This study aimed to develop models of micro-costs among patients undergoing liver transplantation procedures while comparing the role of individual clinical predictors using tree regression models. METHODS: We prospectively collected micro-cost data from patients undergoing liver transplantation in a tertiary academic center. Data collection was conducted using an Intranet registry integrated into the institution’s database for the storing of financial and clinical data for transplantation cases. RESULTS: A total of 278 patients were included and accounted for 300 procedures. When evaluating specific costs for the operating room, intensive care unit and ward, we found that in all of the sectors but the ward, human resources were responsible for the highest costs. High cost supplies were important drivers for the operating room, whereas drugs were among the top four drivers for all sectors. When evaluating the predictors of total cost, a MELD score greater than 30 was the most important predictor of high cost, followed by a Donor Risk Index greater than 1.8. CONCLUSION: By focusing on the highest cost drivers and predictors, hospitals can initiate programs to reduce cost while maintaining high quality care standards.