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Introduction: Several studies have highlighted the potential benefits of early prophylactic transjugular intrahepatic portosystemic shunt (preemptive TIPS) placement in reducing morbidity and mortality following variceal bleeding (VB). Baveno VII recommends its placement less than 72 h after VB (Child-Pugh class C 7 plus active bleeding). This study aimed to evaluate the effectiveness of preemptive TIPS compared to a control group in a referral center. Methods: The control group included cirrhotic patients with VB and Child-Pugh class C or B with active bleeding, retrospectively selected between 2016 and 2022 and divided into 2 subgroups: those that never underwent TIPS placement during the course of their illness (subgroup A) and those submitted to TIPS placement due to rebleeding (subgroup B). Additionally, patients who received preemptive TIPS placement between August 2022 and January 2024 were prospectively included into the preemptive transjugular intrahepatic portosystemic shunt (pTIPS) group. Results: A total of 47 patients were included, 19 (40.4%) in the pTIPS group and 28 (59.6%) in control group (17 in subgroup A). There were no differences in baseline characteristics between the groups, except hepatic encephalopathy that was significantly higher in the control group when compared to the pTIPS group: 19 (67.9%) versus 6 (31.6%), p = 0.014. Early rebleeding rates were significantly lower in the pTIPS group: 1 (5.3%) versus 13 (46.4%) (p = 0.002). There were no significant differences in 6-week survival between the groups: 25 (89.3%) versus 17 (89.5%), p = 0.683. Regarding hepatic encephalopathy, no significant differences were observed between the control and the pTIPS group: 6 (21.4%) versus 4 (21.1%), p = 0.632, even when comparing subgroup A (4, 23.5%) with the pTIPS group (p = 0.432). Conclusion: This real-world study highlights the potential benefits of preemptive TIPS placement in reducing early relapse of VB, thereby lowering morbidity and complications. The findings advocate for the proactive incorporation of preemptive TIPS into clinical practice to optimize patient outcomes following VB.

In this work, the authors present as an innovation, the homogeneous sulfonation of Udel® polysulfone (PSU) with acetylsulfate (ACS) under reflux at 45°C in dichloromethane and inert N2 atmosphere (g) for 1.5 h. Different proportions of ACS were used, obtaining sulfonated products with varying degrees of sulfonation (DS). Confirmation of sulfonated polysulfone (PSU-S), denominated as PSU-SA (high degree of sulfonation) and PSU-SB (low degree of sulfonation), was carried out by FTIR and 1H NMR. Determination of DS was carried out through thermogravimetric analysis (TGA/DSC), varying indexes between 0.883 and 3.022, which correspond to a sulfonated polymer with ion exchange capacity (IEC) from 1.720 to 4.400 meq/g. The evolution of DS related to methods used was monitored and confirmed by 1H NRM. Sulfonation is undertaken to enhance the suitability of this polymer for future applications in the production of biofuels, targeting its utilization in catalytic processes for esterification and transesterification mechanisms of oils and fats.

Abstract Background Ultrasound-based classification systems allow stratification of thyroid nodules to recommend fine-needle aspiration (FNA) based on their malignancy risk. However, these have discrepancies that may have an impact in thyroid cancer detection. We aimed to compare European Thyroid Association (EU-TIRADS) and American College of Radiology (ACR TI-RADS), in terms of FNA indication and diagnostic performance. Methods Retrospective study of 665 thyroid nodules from 598 patients who underwent ultrasound and fine-needle aspiration at a tertiary-care institution between January 1st of 2016 and July 31st of 2019. Based on their sonographic features they were classified according to the EU-TIRADS and ACR TI-RADS classification and then their cytological results were obtained. Differences in FNA indications according to these two classifications were analysed. In patients who underwent surgical removal of the nodules, the final pathological diagnosis was obtained. Results A statistically significant association was found between EU-TIRADS and ACR TI-RADS classification systems (p

Introduction: Parastomal variceal bleeding (PVB) is a recognized complication of ostomized patients in the presence of portal hypertension. However, since there are few reported cases, a therapeutic algorithm has not yet been established. Case Presentation: A 63-year-old man, who had undergone a definitive colostomy, recurrently presented to the emergency department hemorrhage of bright red blood from his colostomy bag, initially assumed to be caused by stoma trauma. Accordingly, temporary success on local approaches such as direct compression, silver nitrate application and suture ligation was achieved. However, bleeding recurred, requiring transfusion of red blood cell concentrate and hospitalization. The patient’s evaluation showed chronic liver disease with massive collateral circulation, particularly at the colostomy site. After a PVB with associated hypovolemic shock, the patient was submitted to a balloon-occluded retrograde transvenous obliteration (BRTO) procedure which stopped the bleeding successfully. The patient was subsequently proposed for a transjugular intrahepatic portosystemic shunt (TIPS) conjugated with percutaneous transhepatic obliteration (PTO). After an initial refusal by the patient, a new episode of self-limited PVB resulted in execution of the procedure. Four months later, in a routine consultation, the patient presented with grade II hepatic encephalopathy, successfully treated with medical therapy. After a 9-month follow-up, he remained clinically well and without further episodes of PVB or other adverse effects. Discussion: This report highlights the importance of a high index of suspicion when dealing with significant stomal hemorrhage. Portal hypertension as an etiology of this entity may compel to a specific approach to prevent recurrence of bleeding, including conjugation of endovascular procedures. The authors pre­sent a case of PVB, initially submitted to a variety of treatment options including BRTO, which was successfully addressed with conjugated treatment of TIPS and PTO.

Resumo Fundamento A cardiomiopatia hipertrófica (CMH) e a hipertrofia ventricular esquerda (HVE) secundária à hipertensão arterial sistêmica (HAS) podem estar associadas a anormalidades funcionais do átrio esquerdo (AE). Objetivos Caracterizar a mecânica do AE na CMH e na HAS e avaliar qualquer correlação com a extensão da fibrose ventricular esquerda medida por ressonância magnética cardíaca (RMC) em pacientes com CMH. Métodos A função longitudinal do AE derivada do ecocardiograma bidimensional com speckle tracking foi adquirida a partir de cortes apicais de 60 pacientes com CMH e 34 indivíduos controles, pareados por idade. Pacientes com CMH também foram submetidos à RMC, com medida da extensão do realce tardio por gadolínio. A associação com parâmetros de strain do AE foi analisada. Valores p < 0,05 foram definidos como estatisticamente significativos. Resultados A média da fração de ejeção do ventrículo esquerdo não foi diferente entre os grupos. A razão E/e’ estava comprometida no grupo CMH e preservada no grupo controle. A mecânica do AE estava significativamente reduzida na CMH em comparação aos pacientes com HAS. O strain rate do AE nas fases de reservatório (SRrAE) e na fase contrátil (SRctAE) foram os melhores parâmetros de discriminação de CMH com uma área sob a curva (AUC) de 0,8, seguido do strain do AE na fase de reservatório (SrAE) (AUC 0,76). O SRrAE e o SRctAE apresentaram elevada especificidade (89% e 91%, respectivamente), e o SrAE apresentou sensibilidade de 80%. Um decréscimo de 2,79% no strain rate do AE na fase de condução (SRcdAE) foi preditor de um aumento de 1 cm na extensão do RT pelo gadolínio (r2=0,42, β 2,79, p=0,027). Conclusões O SRrAE e o SRctAE foram os melhores fatores de discriminação de HVE secundária à CMH. O SRcdAE foi preditor do grau de fibrose ventricular esquerda avaliada por RMC. Esses achados sugerem que a mecânica do AE pode ser um potencial preditor de gravidade de doença na CMH.

Congenital extrahepatic portosystemic shunts are a rare cause of lower gastrointestinal bleeding in children. They result from the connection of a systemic vessel with the portomesenteric vasculature before the division of the main portal vein. Herein, we report a case of a congenital extrahepatic portosystemic shunts type II in a 4-year-old male diagnosed by Doppler ultrasonography during the investigation of abdominal pain and recurrent hematochezia, later confirmed by computed tomography. Conventional angiography with a balloon occlusion test revealed patent intrahepatic portal branches not depicted by previous imaging techniques. Successful shunt closure was achieved by endovascular approach with an Amplatzer Septal Occluder without complications.

Abstract Background Congenital extrahepatic portosystemic shunts (CEPS) are rare shunts connecting the extrahepatic portal system with the inferior vena cava. Shunt dimensions and the risk of portal hypertension determines the closure strategy. Endovascular treatment is indicated for single stage occlusion of longer length shunts, whereas the remaining shunt types are preferentially surgically occluded. Herein we describe the technical details of a novel endovascular treatment for short length CEPS. Case presentation A 15-years-old male with a short length CEPS complicated with multinodular liver disease was submitted to a multistage closure, as indicated by the high portal pressure values during shunt balloon occlusion venography. Initially a transjugular intrahepatic portosystemic shunt (TIPS) was created and the CEPS occluded with an atrial septal defect occluder. In a second procedure the TIPS was embolized with a flow reductor stent and an amplatzer vascular plug II. At a 1 year follow up the liver nodules size reduced, the patient remains asymptomatic, and the shunt adequately closed. Conclusion This paper outlines the potential use of a TIPS and an atrial septal defect occluder combination in complex CEPS, supporting its usage as an alternative to the standard surgical treatment. Level of Evidence: Level 4, Case report.

Prostate cancer ranks as the second most frequently diagnosed cancer globally among men and stands as the fifth leading cause of cancer-related death in males. Hence, an early and precise diagnosis and staging are critical. Traditional staging is based on clinical nomograms but presents a lower performance than prostate multiparametric magnetic resonance imaging (mpMRI). Since tumor staging serves as the basis for risk stratification, prognosis, and treatment decision-making, the primary objective of mpMRI is to distinguish between organ-confined and locally advanced diseases. Therefore, this imaging modality has emerged as the optimal selection for the local staging of prostate cancer, offering incremental value in evaluating pelvic nodal disease and bone involvement, and supplying supplementary insights regarding the precise location and disease extension. As per the Prostate Imaging Reporting & Data System v2.1 guideline, a comprehensive and accurate mpMRI requires several key sequences, which include T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) for morphological assessment, with T2WI serving as the cornerstone for local staging. Additionally, diffusion-weighted imaging (DWI) and dynamic sequences acquired with intravenous administration of paramagnetic contrast medium (DCE) are crucial components. It is worth noting that while MRI exhibits high specificity, its sensitivity in diagnosing extracapsular extension, seminal vesicle invasion, and lymph node metastases is limited. Moreover, mpMRI has its own constraints and is not as effective in detecting distant metastases or evaluating lymph nodes, for which extended pelvic lymph node dissection remains the gold standard. This review aims to highlight the significance of mpMRI in prostate cancer staging and provide a practical approach to assessing extracapsular extension, seminal vesicle invasions, and the involvement of adjacent organs and lymph nodes.

Abstract Background Three-dimensional (3D) models are increasingly used to help surgeons, guiding them through the complex hepatic vasculobiliary anatomy. The biliary tract is a relatively untapped territory with only a few case reports described in medical literature. Our aim is to present an innovative 3D reconstruction methodology for biliary imaging and surgical planning, applied to a case of iatrogenic biliary stricture, with fusion of segmented CT and MRI images. Case presentation A selected case of Bismuth type III iatrogenic biliary stenosis for 3D planning. CT and MR studies were acquired with dedicated protocols for segmentation. Two radiologists performed segmentation and 3D model post-processing, fusing both imaging techniques to faithfully render the anatomical structures. Measurements of anatomical landmarks were taken in both the CT/MRI and the 3D model to assure its accuracy and differences in measurement were calculated. The 3D model replicates anatomical structures and pathology with high accuracy, with only 2.2% variation between STL, CT and MRI measurements. The model was discussed with the surgical team and used in the surgical planning, improving confidence in this delicate procedure, due to the detailed prior knowledge of the patient's anatomy. Conclusion Three-dimensional reconstructions are a rapidly growing area of research with a significant impact in the personalized and precision medicine. The construction of 3D models that combine vascular and biliary anatomy, using different imaging techniques, respectively CT and MRI, will predictably contribute to a more rigorous planning of complex liver surgeries.

Our aim was to study the association between preoperative biliary drainage (PBD) and morbidity following cephalic pancreaticoduodenectomy (CPD) for pancreatic ductal adenocarcinoma (PDAC) and its prognostic impact, which is still controversial in the literature. A retrospective study was conducted, which included 128 patients who underwent CPD for PDAC, divided into two groups: those who underwent PBD (group 1) and those who did not undergo this procedure (group 2). Group 1 was subdivided according to the drainage route: endoscopic retrograde cholangiopancreatography (ERCP), group 1.1, and percutaneous transhepatic cholangiography (PTC), group 1.2. 34.4% of patients underwent PBD, and 47.7% developed PBD-related complications, with 37% in group 1.1 and 64.7% in group 1.2 (p = 0.074). There was a significant difference between group 1 and 2 regarding bacterial colonization of the bile (45.5% vs. 3.6%, p < 0.001), but no difference was found in the colonization by multidrug-resistant bacteria, the development of Clavien–Dindo ≥ III complications, clinically relevant pancreatic fistula and delayed gastric emptying (DGE), intra-abdominal abscess, hemorrhage, superficial surgical site infection (SSI), and readmission. Between groups 1.1 and 1.2, there was a significant difference in clinically relevant DGE (44.4% vs. 5.9%, p = 0.014) and Clavien–Dindo ≥ III complications (59.3% vs. 88.2%, p = 0.040). There were no significant differences in median overall survival and disease-free survival (DFS) between groups 1 and 2. Groups 1.1 and 1.2 had a significant difference in DFS (10 vs. 5 months, p = 0.017). In this group of patients, PBD was associated with increased bacterial colonization of the bile, without a significant increase in postoperative complications or influence in survival. ERCP seems to contribute to the development of clinically significant DGE. Patients undergoing PTC appear to have an early recurrence.

A diabetes é uma doença crónica muito frequente na população portuguesa, sendo a sua prevalência estimada de 13,6% nos adultos. A melhor preparação e os riscos associados à realização de exames de imagem em pessoas com diabetes são frequentemente objeto de dúvidas. Neste artigo, pretendemos rever as principais precauções e sugerir um protocolo de atuação, de forma a reduzir os riscos e otimizar a sensibilidade destes exames nesta população. Revemos também a necessidade de suspensão de metformina após a administração de contraste iodado endovascular, pelo risco de acidose láctica, as precauções em pessoas com diabetes insulinotratadas ou sob fármacos que apresentam maior risco de hipoglicemia na realização de exames de imagem que obriguem a jejum, e a influência da hiperglicemia e da terapêutica anti-diabética na sensibilidade da PET-FDG. Com a revisão deste tema e apresentação de um protocolo de atuação pretendemos desmistificar a orientação dos indivíduos com diabetes que vão ser submetidos a exames de imagem, tornando mais simples a sua gestão.

Ovarian cancer is the most fatal gynecologic malignancy. The incidence of ovarian cancer among female-to-male transsexuals receiving treatment with testosterone is unknown, and few cases have been reported in the literature. We report a recent case in our institution, a 23-year-old female-to-male transsexual patient who received testosterone supplementation. The patient underwent a pelvic magnetic resonance imaging to study an ovarian complex cyst that revealed the presence of a bilateral ovarian tumor with imaging features of borderline serous tumor. These masses were surgically removed and the pathology report confirmed the diagnosis associated with noninvasive peritoneal implants and the presence of numerous androgen receptors in the tumor cells. Although there is still insufficient data to validate a direct correlation between hormonotherapy and ovarian cancer in these patients, this case may reinforce previous reports on this association and highlights the relevance of radiological follow-up and bilateral salpingo-oophorectomy as part of gender reassignment surgery.

Cardiac magnetic resonance has become a reliable imaging modality providing structural and functional data, and fundamental information about tissue composition. Cardiac magnetic resonance imaging with late gadolinium enhancement, T1-mapping, T2-mapping, T2*-imaging, and extracellular volume, has proved to be a valuable tool in investigating the etiology of heart failure. Such analysis is helpful for the diagnostic evaluation of both ischemic and non-ischemic cardiomyopathies. As primary heart muscle diseases, the ability to characterize the myocardial substrate is essential. Determining the heart failure etiology is fundamental and has implications regarding the prognosis prediction and best treatment. Investigation in cardiac magnetic resonance in heart failure patients has grown in the past decade, and the true value of this imaging modality to detect early disease likely remains underestimated. This review describes the importance of cardiac magnetic resonance for the diagnosis and prognosis of non-ischemic cardiomyopathies, particularly hypertrophic, infiltrative, and arrhythmogenic cardiomyopathies.

OBJECTIVE: Macroporous cement with mechanical properties similar to cancellous bone may improve the treatment of large bone defects in relation to solid acrylic cement. The aim of this study was to compare physical and mechanical characteristics of a polymethyl methacrylate (PMMA) based porous cement with cancellous bone. METHODS: Compressive strength and pore size, interconnectivity, and distribution of cylindrical porous PMMA cement samples containing 10% (G1), 20% (G2) or 30% (G3) effervescent components were analyzed. Results were compared to bovine cancellous bone (G4) and solid PMMA (G5) samples. RESULTS: Scanning electron microscopy (SEM) of all experimental samples (G1 - G3) revealed a random distribution and a wide size variation of pores ranging from 50 µm to 3 mm. Micro-CT showed that G2 have high porosity and lower interconnectivity of pores. No significant differences in yield strength and Young's modulus were observed among G1, G2 and G3. G4 samples were slightly stronger and less elastic than the other groups. Solid PMMA is extremely strong and inelastic. CONCLUSIONS: PMMA based porous cement met the expected characteristics. High porosity with large and interconnected pores may allow for bone ingrowth. Strength and elasticity similar to cancellous bone may enhance mechanical stimuli to bone remodeling. Observational Descriptive Study.

We report the approach to a 29 year old patient presenting with the diagnosis of a Budd-Chiari Syndrome, with clinical deterioration after initial anticoagulation treatment.The patient was proposed to endovascular treatment.Through intra-hepatic shunting seen at angiography, and from a left to right liver lobe, a guide-wire was passed retrogadely and allowed sufficient support to perform hepatic vein angioplasty and stenting.The patient responded favourably and liver transplant was avoided. Keywords: Budd-Chiari, Angioplasty, Hepatic-vein, Interventional radiology

We report the imaging findings of an uncommon coronary vascular termination anomaly, with fistula to the pulmonary artery.This 70 year old female patient presented unstable angina, showing a coronary artery fistula depicted in coronary angiogram from the left coronary to the pulmonary artery, with no significant atherosclerotic pathology.Due to development of ventricular tachycardia in stress echocardiogram examination, she was proposed for coronary fistula closure.Coronary CT was performed for procedure planning and allowed the identification of a second unsuspected fistula from the right coronary to the right pulmonary artery.Congenital coronary anomalies are a possible cause of symptomatic coronary pathology in patients of any age. In older patients, coronary artery fistulas are rare, especially when symptomatic. Adequately performed CT examinations, using its post processing capabilities, with 3D and MIP reconstructions are invaluable in delineating coronary anatomy, essential for further treatment planning. Keywords: Coronary anomalies, Coronary fistula, Angiogram, Computer tomography

Resumo: Introdução: A ressonância magnética cardíaca (RMC) tem vindo a adquirir grande relevância na avaliação diagnóstica de um espectro cada vez mais amplo de cardiomiopatias, incluindo as que apresentam potencial arritmogénico. Objetivo: Avaliação do valor acrescentado da RMC no diagnóstico etiológico de arritmias ventriculares, quando a investigação convencional inicial com outros métodos complementares de diagnóstico não é conclusiva. Métodos: Estudaram-se retrospetivamente os doentes que realizaram RMC para esclarecimento da etiologia de arritmias ventriculares, entre 2005-2011 (n = 113). Foram incluídos apenas doentes com arritmias ventriculares documentadas. Constituíram critérios de exclusão a obtenção de diagnóstico definitivo por exame complementar, de diagnóstico realizado previamente e a presença de história prévia sugestiva de doença coronária (antecedentes de síndrome coronária aguda ou história de angor típico, de elevação de biomarcadores de necrose miocárdica ou teste de isquemia positivo, quando realizado). Os resultados da RMC foram considerados relevantes quando sugeriram um diagnóstico provável. Resultados: Dos 113 doentes incluídos, 57,5% eram homens. A idade média foi 41,7 ± 16,2 anos. Quanto à arritmia documentada, 38,1% dos doentes foram referenciados por taquicardia ventricular/fibrilhação ventricular (FV/TV mantida) e 61,9% por extrassistolia ventricular com menor complexidade (ESV). A RMC mostrou alterações sugestivas de um diagnóstico específico em 42,5% dos doentes, foi totalmente normal em 36,3% e mostrou alterações inespecíficas nos restantes. Nos casos de referenciação por FV/TV mantida a RMC foi diagnóstica em 60,4% dos casos, enquanto nos casos de ESV foi-o em 31,4%.Os diagnósticos prováveis mais frequentes foram displasia arritmogénica do ventrículo direito, não compactação ventricular e miopericardite. Assinala-se que, apesar da ausência de evidências clínicas sugestivas pelos critérios atrás referidos, 6,2% dos doentes apresentaram áreas de realce tardio com distribuição e características atribuíveis a doença coronária obstrutiva. Conclusão: A RMC proporciona valor acrescentado no diagnóstico etiológico de arritmias ventriculares quando exames mais acessíveis ou realizados previamente não são conclusivos. A percentagem de doentes em que foi conclusiva foi de 42,5% (60,4% nos casos de referenciação por FV/TV mantida) e em que foi totalmente normal foi de 36,3%. Abstract: Introduction: Cardiac magnetic resonance (CMR) imaging is increasingly important in the diagnostic work-up of a wide range of heart diseases, including those with arrhythmogenic potential. Objective: To assess the added value of CMR in etiological diagnosis of ventricular arrhythmias after an inconclusive conventional investigation. Methods: Patients undergoing CMR between 2005 and 2011 for investigation of ventricular arrhythmias were included (n=113). All had documented arrhythmias. Those with a definite diagnosis from a previous investigation and those with evidence of coronary artery disease (acute coronary syndrome, typical angina symptoms, increase in biomarkers or positive stress test) were excluded. CMR results were considered relevant when they fulfilled diagnostic criteria. Results: Of the 113 patients, 57.5% were male and mean age was 41.7±16.2 years. Regarding the initial arrhythmia, 38.1% had ventricular fibrillation/sustained ventricular tachycardia (VF/VT) and 61.9% had less complex ventricular ectopy. CMR imaging showed criteria of a specific diagnosis in 42.5% of patients, was totally normal in 36.3%, and showed non-specific alterations in the remainder. In VF/VT patients, specific criteria were found in 60.4%, and in 31.4% of those with less complex ectopy.The most frequent diagnoses were arrhythmogenic right ventricular dysplasia, ventricular non-compaction and myopericarditis. It is worth noting that, although there was no evidence of previous coronary artery disease, 6.2% of patients had a late gadolinium enhancement distribution pattern compatible with myocardial infarction. Conclusion: CMR gives additional and important information in the diagnostic work-up of ventricular arrhythmias after an inconclusive initial investigation. The proportion of patients with diagnostic criteria was 42.5% (60.0% in those with VF/VT), and CMR was completely normal in 36.6%. Palavras-chave: Ressonância magnética cardíaca, Etiologia de arritmias ventriculares, Substrato arritmogénico, Keywords: Cardiac magnetic resonance, Diagnosis of ventricular arrhythmias, Arrhythmogenic substrate

Resumo: Um dos obstáculos a uma utilização mais frequente e apropriada da ressonância magnética cardíaca (RMC) em Portugal tem sido a ausência de códigos específicos que descrevam adequadamente os exames tal como são efetuados actualmente. Este documento de consenso fornece recomendações para a atualização e uniformização dos códigos empregues na RMC. São igualmente feitas recomendações quanto às técnicas e códigos a utilizar nas indicações clínicas mais frequentes. Abstract: One of the obstacles to more frequent and appropriate use of cardiac magnetic resonance (CMR) in Portugal has been the lack of specific codes that accurately describe these examinations as they are currently performed. In this consensus document, recommendations are made for updating and standardizing CMR codes in Portugal. Guidance on which techniques and codes should be used in the most common clinical scenarios is also provided. Palavras-chave: Ressonância magnética cardíaca, Codificação, Consenso, Keywords: Cardiac magnetic resonance, Coding, Consensus

Resumo: Introdução e objectivos: A isquémia do miocárdio pode ser avaliada através da ressonância magnética de perfusão (RMp). O objetivo do trabalho foi avaliar o uso clínico da RMp no estudo da doença cardíaca isquémica (DCI). Métodos: Foram estudados 55 doentes através de RMp, num aparelho de 1,5 T (Siemens Symphony), através da injeção de quelato de gadolínio (0,10 mmol/kg), utilizando uma sequência IR-SSFP. O stress foi induzido pela adenosina (140 μg/kg/min durante 4 min). Os resultados foram comparados com os das coronariografias e das cintigrafias de perfusão do miocárdio. A concordância entre as variáveis qualitativas foi a avaliada através do coeficiente kappa. Foi considerada significância estatística a 95%. Efetuou-se um follow-up clínico mínimo de 12 meses. Resultados: Das 55 ressonâncias magnéticas (RM) efetuadas, em 19 (34,5%) não se detetou isquemia ou necrose do miocárdio, em 17 (30,9%) foi diagnosticada área de necrose sem isquemia, em 7 (12,7%) isquemia isolada e em 12 (21,8%) isquemia em doente com enfarte prévio. A comparação específica em função do território de irrigação coronária entre a RMp e a coronariografia foi muito boa: descendente anterior e coronária direita – k = 0,8571; intervalo 0,59-1, circunflexa – k = 0,8108; intervalo 0,59-1. Não se conseguiu obter qualquer razão de concordância entre as RMp e as cintigrafias realizadas. Conclusões: Numa população com elevada prevalência de doença coronária, a RMp mostrou ser um exame capaz de diagnosticar doença coronária significativa, através da identificação de isquemia do miocárdio. Abstract: Introduction and objectives: Myocardial ischemia can be assessed with cardiac magnetic resonance perfusion imaging (MRPI). This study aimed to analyze the clinical utility of MRPI in the diagnosis of significant coronary artery disease. Methods: Fifty-five patients were examined with a 1.5 T MR scanner (Siemens Symphony), with a first pass of 0.10 mmol/kg gadolinium chelate, at rest and during adenosine vasodilatation (140 μg/kg/min for 4 min) using an inversion recovery steady-state free precession sequence. The results were compared with coronary angiography and with SPECT myocardial perfusion images. Agreement for qualitative diagnosis was measured by the kappa coefficient, taking statistical significance as 95%. Minimum clinical follow-up was 12 months. Results: In 19 patients (34.5%) MRPI was negative for myocardial ischemia and necrosis, in 17 (30.9%) it was negative for ischemia but positive for necrosis, in 7 (12.7%) only ischemia was present and in 12 (21.8%) the ischemic area was larger than the necrotic area. The correlation between MRPI and coronary angiography for ischemia detection by coronary artery territory was very good: left anterior descending and right coronary – k=0.8571 (0.59-1), circumflex – k=0.8108 (0.59-1). By contrast, there was no correlation in terms of myocardial ischemia detection between MRPI and SPECT. Conclusions: MRPI is able to diagnose significant coronary disease in a high risk population, by detection of myocardial ischemia. Palavras-chave: Ressonância magnética, Perfusão, Doença coronária, Ressonância magnética de perfusão, Keywords: Magnetic resonance imaging, Perfusion, Coronary disease, Myocardial Perfusion Imaging

Renal artery aneurysms are a rare cause of secondary hypertension. Endovascular treatment with a polytetrafluoroethylene (PTFE)-coated stent can exclude aneurysms and treat hypertension. We report the case of a 23-year-old man with hypertension diagnosed three years earlier and in whom renal angiography revealed three aneurysms involving the right renal artery. A covered stent was implanted, resulting in successful exclusion of the aneurysm. Ten months after the procedure the patient is asymptomatic and with normal blood pressure without antihypertensive therapy. Resumo: Os aneurismas da artéria renal representam uma causa rara de hipertensão secundária. O tratamento endovascular com stent revestido por politetrafluoretileno (PTFE) consiste numa abordagem que permite excluir os aneurismas e tratar a hipertensão. Apresentamos o caso de um jovem de 23 anos, com o diagnóstico de hipertensão há três anos e cuja angiografia renal mostrou três aneurismas na dependência da artéria renal direita. Procedeu-se à implantação de um stent revestido por PTFE com a exclusão bem sucedida dos aneurismas. Dez meses após o procedimento o doente está assintomático e com valores normais de tensão arterial sem terapêutica anti hipertensora. Keywords: Renovascular hypertension, Renal artery aneurysm, Endovascular repair, Renal stent, Palavras-chave: Hipertensão renovascular, Aneurisma da artéria renal, Tratamento endovascular, Stent renal

In this work, the authors present as an innovation, the homogeneous sulfonation of Udel® polysulfone (PSU) with acetylsulfate (ACS) under reflux at 45°C in dichloromethane and inert N2 atmosphere (g) for 1.5 h. Different proportions of ACS were used, obtaining sulfonated products with varying degrees of sulfonation (DS). Confirmation of sulfonated polysulfone (PSU-S), denominated as PSU-SA (high degree of sulfonation) and PSU-SB (low degree of sulfonation), was carried out by FTIR and ¹H NMR. Determination of DS was carried out through thermogravimetric analysis (TGA/DSC), varying indexes between 0.883 and 3.022, which correspond to a sulfonated polymer with ion exchange capacity (IEC) from 1.720 to 4.400 meq/g. The evolution of DS related to methods used was monitored and confirmed by ¹H NRM. Sulfonation is undertaken to enhance the suitability of this polymer for future applications in the production of biofuels, targeting its utilization in catalytic processes for esterification and transesterification mechanisms of oils and fats. [ABSTRACT FROM AUTHOR]