In our experience, primary CT-guided percutaneous catheter drainage was successful for approximately one half of the patients with acute necrotizing pancreatitis. The presence of multisystem organ failure appears to be a more important indicator of outcome than does the presence of infection.

Nutritional intervention as exclusive treatment, with a loss of at least 5% of initial weight, is effective in the treatment of non-alcoholic fatty liver disease.

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CT-guided percutaneous RFA was a safe and effective treatment for functioning adrenal adenomas, with short hospital length of stay and low complication rate.

Helminth infection is not as prevalent as previously reported in urban slums in São Paulo, neither as clinical disease nor in soil samples. Protozoa intestinal infection, however, is still frequent in some marginalized populations in São Paulo. Improvement in living standards, mostly sanitation might decrease the prevalence of these diseases.

Background: Invasive and non-invasive tests have been used to identify the risk of ventricular tachycardia (VT) in patients with chagas' cardiomyopathy (CCM). Cardiac magnetic resonance imaging (CMRI) using the delayed enhancement (DE) technique can be useful to select patients with global or segmentary ventricular dysfunction, with high degree of fibrosis and at higher risk for clinical VT.

Cesarean scar pregnancy is a rare form of ectopic pregnancy. It is associated with many complications, including a high risk of massive bleeding and hysterectomy under unfavorable conditions. Conservative treatment with systemic methotrexate (MTX) has been used preferentially with the aim of allowing the patient to have a reproductive future. However, cases of complex ectopic masses in a cesarean scar with guarded prognosis demand techniques that are more effective, such as uterine artery embolization (UAE) in association with intra-arterial MTX infusion. We describe the case of a 35-year-old patient in the 8th week of pregnancy who was referred to us because of genital bleeding and suspected ectopic pregnancy in the cesarean scar. After confirmation of the diagnosis, an initial attempt at systemic treatment with MTX was made. This was abandoned due to the elevation of the hepatic transaminase level. In addition, because of the complexity of the mass and the patient's desire to preserve her reproductive capacity, it was decided to perform UAE with local MTX infusion. The procedure was performed successfully and the patient's fertility was preserved.

Background and aimThere are several prognostic systems that address different aspects of the patient and the tumour and can guide the management of patients with hepatocellular carcinoma (HCC). This study aimed to evaluate and compare the eight staging systems for a group of patients in a public service in Brazil.MethodsPatients with HCC were retrospectively analysed between 2000 and 2012. The prognostic systems Okuda, The Cancer of the Liver Italian Program (CLIP), the Chinese University Prognostic Index (CUPI), Groupe d'Etude et de Traitément du Carcinome Hepatocellulaire (GRETCH), the modified TNM-based Japan Integrated Score (JIS) combined with alpha-fetoprotein and Child-Turcotte-Pugh (CTP), the TNM system, and the Barcelona Clinic Liver Cancer Classification (BCLC) were applied to these patients and compared through model fit measurements, likelihood scores, and the Akaike Information Criterion (AIC).ResultsA total of 247 patients were studied. The average survival time was 60 months. The TNM, Okuda, CLIP, GRETCH, modified JIS, and BCLC systems were well correlated with one another and individually important to the prediction of survival among the patients studied. However, in the statistical analysis, the CUPI delivered the best predictive performance (AIC = 566; log-likelihood = -281,240).ConclusionAlthough the CUPI system was demonstrated to be the most appropriate HCC staging system for the studied population, the choice of an ideal system is a controversial subject, and future studies with larger numbers of patients are necessary for the validation of the CUPI system as the method of choice for other populations.