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Chyle leak (CL) after head and neck surgery is a rare but well-known complication. In patients with high-output leakage, the treatment can be complicated. This study aims to report on a recent innovation in lymphatic intervention for treating such patients. Materials and Methods: A retrospective review of 36 patients with chyle leak after neck surgery for thyroid cancer was conducted to assess the efficacy of percutaneous lymphatic embolization and thoracic duct (TD) disruption. Results: Antegrade catheterization of the thoracic duct was achieved in 31 of 36 patients (86.1%). Therefore, embolization of the thoracic duct and thoracic duct branches was performed in 26 and 5 patients, respectively. In 5 cases of unsuccessful antegrade catheterization into the thoracic duct, transcervical access embolization was performed in 2 patients, and TD disruption (TDD) was performed in 3 patients. The pooled overall technical success rate of lymphatic embolization was 33/36 patients (91.7%). One patient who underwent thoracic duct embolization (TDE) with technical success (1/33 patients) but clinical failure had additional treatment directly sclerosing the TD under computed tomography scan. Cervical fluid collection sclerotherapy was done in 7 patients as an additional treatment. Resolution of the chyle leak after procedures was observed in all patients (100%). The mean time to resolution was 3 days (1– 7 days). There was no complication intra and after procedures. Conclusion: TDE, selective TD branches embolization and TDD are safe and effective minimally invasive treatments for CL post-surgery for thyroid carcinoma. Sclerosing cervical fluid collection contributes to clinical success. [ABSTRACT FROM AUTHOR]

Purpose: This article described intranodal lymphangiography and embolization of patients with lymphatic leak post-operation of the groin region for various aetiologies (lymph node resection, femoral artery exposure). Materials and Methods: A retrospective analysis from 2018 to 2020 was performed and twelve consecutive patients underwent intranodal lymphangiography and intranodal lymphatic embolization to treat lymphorrhea or lymphocele post-operation of the groin. All the lymph nodes around the wound were punctured for lymphangiography. If the extravasation was found from the lymph node, the glue N-butyl cyanoacrylate (NBCA) diluted with lipiodol (ratio of 1:4) was injected to occlude the lymphatic vessel laceration. Results: All the lymph nodes around the wound were punctured with the median number of two lymph nodes for each patient (range from one to four lymph nodes); there were three patients with two leakage points. Intranodal lymphatic embolization was performed by glue NBCA diluted 1:4 with lipiodol. Additional treatment includes sclerotherapy (n=5) and percutaneous muscular flap operation (n=1). Clinical successful was achieved in twelve patients (100%) with no major complications. One patient experienced lymphedema which was was treated by compression stockings and rehabilitation therapy. Conclusion: Intranodal lymphangiography and embolization are effective methods to treat iatrogenic lymphatic leak while all the lymph nodes around the wound should be punctured to avoid missing lesions from other lymphatic vessels. [ABSTRACT FROM AUTHOR]

Background. Breast cancer is the most common malignancy diagnosed in women, and the incidence gradually increases. Magnetic resonance imaging (MRI) is become widely used to identify benign and malignant breast tumors. Objective: The aim of this study was to evaluate the relationships between apparent diffusion coefficient (ADC) values and histopathologic prognostic factors in breast cancer. Methods. Forty-nine breast carcinoma patients were included evaluated for prognostic factors, including histological type, histological grade, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and molecular subtype. Minimum (ADCmin) and mean (ADCmean) ADC values were compared among prognostic factor groups by Mann–Whitney U test and Kruskal–Wallis test. Results. Lower mean ADCmin and ADCmean values were observed for no special type (NST) than for invasive lobular carcinoma (ILC) type (0.81 ± 0.03 × 10−3 and 0.96 ± 0.03 × 10−3 mm2 /s, P= 0.002 and 0.03, respectively). The mean ADCmin and ADCmean values for the highlevel Ki-67 group were significantly lower than those for the low-level Ki-67 group (P = 0.001 and 0.008, respectively). No correlations were observed between ADC values and histological grades, ER, PR, HER2, and molecular subtypes. Conclusion. ADCmin and ADCmean values correlated with the proliferation marker Ki-67 and histological grade. ADC values can serve as noninvasive indicators of cell proliferation in breast cancer. [ABSTRACT FROM AUTHOR]

Background: Generally, there are many methods for the treatment of urinary stones, of which percutaneous nephrolithotomy (PCNL) is a minimally invasive and highly effective method, and now become the first-line management for urinary stones, especially in the cases of complex stones and staghorne calculi. Accurate assessment of stone location, stone morphology, degree of hydronephrosis as well as urinary system abnormalities is extremely important in the percutaneous nephrolithotomy strategy., Objective: The aim of this study was to evaluate the S.T.O.N.E score as well as other factors that influenced the effectiveness of PCNL., Methods: Descriptive study on 71 patients with kidney stones, who underwent multi-slice CT scan of the urinary system before PCNL and then PCNL at Hanoi Medical University Hospital from July 2022 to July 2023. All patients received the informed consent and agreed to participate in the study. The factors included the stone area, the track length (from the skin surface to the stone central), the degree of urinary tract dilatation, the number of involved calyces, the density of stone, the renal parenchyma thickness, the ureteral wall thickness and fat infiltration measured on MSCT non-contrast phase. These factors were used to predict the effectiveness of PCNL including the stone clearance rate (SCR) and the operation time., Results: The mean age of the patient group was 53.8±12.3. The male/female ratio was 1.54. There was a significant difference (p<0.05) between the following factors and the operation time: the stone area (<400, 400-799, 800-1599 and >1600 mm2), the degree of urinary tract dilatation (no or might and moderate or severe dilatation), the number of involved calyces (≤ 2, 3 and staghorne calculi), the renal parenchyma thickness (<18 mm and ≥18mm). In contrast, there were no significant differences between the following factors and the surgery time (p>0.05): the track length (<100 and ≥100 mm), and the stone density (<950 and ≥950 HU). Regarding the S.T.O.N.E score (included five factors: Size, Track length, Obstruction, Number of involved calyces, and Evaluation of stone density), there was a strong correlation between S.T.O.N.E score and the surgery time (p<0.001, r=0.94), and the SCR (p=0.001, r=-0.97)., Conclusion: The evaluation of these factors played an important role in the prediction of the effectiveness of PCNL., Competing Interests: The authors declare no conflict of interests., (© 2024 Tran Quoc Hoa, Than Thi Minh Nguyet, Nguyen Thanh Van Anh, Le Tuan Linh, Nguyen Minh Duc, Hoang Dinh Au.)

Background: The development of gallstones, also known as cholelithiasis, is one of the most common diseases associated with the gastrointestinal tract. In developing countries 10% to 15% of men and >25% of women experience gallstones., Objective: The aim of the study was to evaluate the outcomes following percutaneous transhepatic cholecystolithotomy by holmium laser in non-high-risk patients with symptomatic gallbladder stones., Methods: This was an intervention study without control and with longitudinal follow-up. Subjects included patients who had only gallbladder stones, a normal gallbladder contractility index, and required a conservative treatment., Results: The study included 44 patients (20 men, 24 women), with a mean age of 41.5 ± 13.4 years. The success rate was 97.7%, and only 1 of 44 patients required follow-up laparoscopic cholecystectomy. Gallstones were successfully removed from 43 of 44 patients (97.7%). The complication rate was 13.6% (6/44 patients), and only minor complications were reported for 5 of the 6 patients with complications. In 34 of 43 patients, follow-up examinations were performed after 1 and 6 months. The gallstone recurrence rate at six-month follow-up was 11.8%, and a collapsed gallbladder was detected in 1 of 34 patients, with the remaining 33 patients retaining normal gallbladder contractility indices (>40%)., Conclusion: Percutaneous transhepatic cholecystolithotomy by holmium laser has a high gallstone removal rate (97.7%); however, recurrence remains a major problem. The complication rate was about 13.6%, most of which were minor complications. Cases associated with treatment failure or serious complications should be detected and treated promptly., Competing Interests: There are no conflicts of interest to declare., (© 2022 Nguyen Thai Binh, Ngo-Thi Ly Ly, Phan Nhan Hien, Le Tuan Linh, Bui-Van Lenh, Nguyen Minh Duc.)

Background: Most fetal abnormalities can be detected on ultrasound, the evaluation of fetal CNS abnormalities can be limited by various factors, including obesity, polyhydramnios, multiple pregnancies, and increased cranial ossification during the third trimester., Objective: This study aimed to evaluate the ability to detect fetal central nervous system (CNS) anomalies using in utero magnetic resonance imaging (iuMRI) and ultrasound (US) techniques., Methods: This prospective study was approved by the institutional review board (Ref: 2968/QĐ-ĐHYHN dated 11 July 2019), and the requirement to obtain the informed consent of patients was waived. This study included 66 fetuses with diagnosed or suspected CNS abnormalities based on the results of a prenatal screening US performed at the antenatal diagnosis center of the Central Obstetrics and Gynecology Hospital. All pregnant women with a suspected diagnosis of abnormal fetal CNS on US underwent 1.5-Tesla iuMRI within 14 days of the US at Hanoi Medical University Hospital between June 2019 and June 2020. Cohen's kappa coefficient (κ) was used to determine the agreement between US and iuMRI findings., Results: A total of 66 pregnant women were examined, including 66 fetuses, for which 79 abnormalities were detected by US and 98 abnormalities were detected by iuMRI. The average gestational age was 29 weeks and 6 days. The comparison of iuMRI and US findings revealed similar diagnoses for 71 abnormalities (67%) and different diagnoses for 35 abnormalities (33%). The level of agreement between US and iuMRI was almost perfect for ventriculomegaly and cystic lesions, with κ values 0.87 and 0.84, respectively. The level of agreement between US and iuMRI was the weakest for hemorrhage, with a κ value 0 (no agreement), and cortical abnormalities, with a κ value of 0.46 (weak agreement)., Conclusion: The level of agreement between US and iuMRI diagnoses was almost perfect for the detection of ventriculomegaly and was weakest for the detection of hemorrhage and cortical abnormalities, which were abnormalities detected by iuMRI but not by ultrasound., (© 2021 Le Tuan Linh, Nguyen Minh Duc, Nguyen-Thi Hong Nhung, Thieu-Thi Tra My, Doan Tien Luu, Bui Van Lenh.)