SUMMARY Nontraumatic chylothorax (NTC) is the presence of chylous fluid in the pleural cavity. Unlike traumatic chylothorax, diagnosis and interventional treatment has very high rate of success while nontraumatic chylothorax has many difficulties in both diagnosis and treatment. The most important in management of NTC is depicting the lesion of lymphatic vessel which is varying from patient to patient. The current understanding of the anatomy of the chylous circulation allows for successful diagnosis and treatment in some patients, but the incidence is still limited. This article reviews the causes of chylothorax and approaches to diagnosis and treatment of patient with NTC. Keywords: chylothorax, thoracic duct embolization *

SUMMARY Background: Mechanical thrombectomy is considered the firstline treatment method for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Two current main techniques include stent retriever and direct aspiration. Recently, endovascular treatment for AIS has reached a great progression, in which the Solumbra technique, a combination of stent retriever and direct aspiration techniques, has been introduced to achieve high rate of recanalization, to minimize the occurrence of distal embolization and to improve clinical outcomes. We reported initial experience utilizing Solumbra technique at Cho Ray Hospital. Materials and Methods: Case series report of patients with acute ischemic stroke treated by Solumbra technique at Choray Hospital, from 01/2019 to 01/2021. Clinical, angiographic and outcome features were collected and evaluated. Results: There were 23 cases treated by Solumbra technique: the mean age was 72 years old, mean NIHSS at admission was 19, good recanalization rate of TICI 2b-3 was achieved in 18/23 (78.3%), functional independence outcomes (90-day mRS 0-2) was 10/23 (43.5%) patients. The embolization to new territories (ENT) was 2/23 (8.7%), the rate of symptomatic intracranial hemorrhage (sICH) was 4/23 (17.4%) and mortality rate was 3/23 (13%) patients during follow-up. The average time from arterial puncture to recanalization was 37.3 minutes. Conclusion: Mechanical thrombectomy using Solumbra technique appeared to be a fast, safe and effective method with high recanalization rate and good clinical outcomes. Solumbra would be a promising technique to reduce thrombus fragmentation and distal embolization. Key words: Acute ischemic stroke, large vessel occlusion, endovascular treatment, Solumbra technique.

SUMMARY Most thyroid nodules are benign and do not require treatment, but large (≥3 cm) benign thyroid nodules usually cause clinical symptoms or cosmetic concerns and therefore require treatment. Traditionally the treatment for benign thyroid nodules consists of surgery and levothyroxine medication, however, both have many drawbacks. Minimally invasive surgical alternatives are becoming more attractive for the treatment of thyroid nodules. Beside Radiofrequency ablation (RFA), Microwave ablation (MWA) is a method of thermal ablation to induce thyroid tissue necrosis and has been applied to various benign and malignant tumors with good results. Objectives: We determine the safety and efficacy of the Microwave Ablation procedure to treat large benign thyroid nodules. Materials and Methods: We report a series of 40 large benign thyroid nodules patients who underwent Microwave Ablation for treatment at Thoracic Surgery Department Cho Ray hospital from Apr-2018 to Sep-2019. Results: There were 31 females and 9 males, with a median age of 46 years. The medians with the largest diameter and volume of the nodules were 40 mm and 22 ml. Four (10%) minor complications were observed. The mean volume reduction ratio (VRR) was 75.1, 85.2, and 96.4% after 3, 6, and 12 months. The mean symptom and cosmetic scores dropped from 8.0 and 2.8 (before treatment) to 2.8 and 1.3 (at 12 months), respectively. Thirteen nodules (31%) require two MWA sessions. Conclusions: MWA is safe, effective, and can be a good option to treat large benign thyroid nodules. More studies with large datasets and long follow-ups are needed to improve its safety and efficacy. Keywords: Large benign thyroid nodules; Microwave ablation (MWA); Volume reduction ratio; Symptom score; Cosmetic score.

Summary Objective: We aimed to evaluate the effectiveness early outcomes of PAE in treating BPH patients with acute urinary retention (AUR). Method and results: in this prospective study approved by the institutional review board, a signed informed consent was obtained. There were fourteen patients with AUR due to BPH from 07/2017 to 07/2018. The patients were successful removal of the bladder catheter after 1216 days. Post-intervention 3 months, average evaluation of IPSS, Qol, PSA (ng/ml) and PV (cm3 ) decreased 63,2%; 73,19%; 79,98; 29,97% (ultrasound) 31,75 (MRI); Qmax 11,46 (ml/s), PVR 55,58 (ml). Conclusion: PAE in patients with AUR due to BPH is safe and effective. Key word: bening prostatic hyperplasia (BPH), Prostatic Artery Embolization (PAE), Acute Urinary Retention (AUR).

SUMMARY Objectives : Study on 18FDG-PET/CT imaging characteristics of lesions in non-small cell lung cancer before treatment and the role of 18FDG-PET/CT in the staging of patients with non-small cell lung cancer. Methods: Retrospective study, descriptive analysis on 43 non-small cell lung cancer patients who were newly detected taken 18FDG-PET/CT at Military Hospital 103 from February 2017 to February 2022, including 32 patients who were indicated for surgery after 18FDG-PET/CT scan without any specific treatment. Results: The average size of lung tumor was 40.98±21.53mm, there was a correlation between SUVmax index and primary tumor size. The SUVmax value increased with stage T. The mean SUVmax value of the lymph node group >10mm was 10.59±6.12 higher than that of the node group <10mm was 5.56±2.47. After PET/CT scan, the N0 stage accounted for 32.6%, the N1 stage accounted for 23.3%, the N2 stage accounted for 23.3%, and the N3 stage accounted for 20.9%. The mean SUVmax value of the tumor in the M1 group of patients was 15.96±4.29, which was higher than that of the M0 group of patients was 14.57±8.26.18FDG-PET/ CT detected 100% of primary tumor lesions in the lung, 18FDG-PET/CT accurately diagnosed stage T at 71.88%, higher than CT with 68.75%, accurately diagnosed stage T at 68.75%. N segment at 81,25%, higher than CT with 75%. Sensitivity, specificity, positive predictive value, negative predictive value of 18FDG-PET/CT in the diagnosis of stage N are: 100%; 68,42%; 68,42% and 100%. Keywords: Non-small cell lung cancer, 18FDG-PET/CT, SUVmax.

SUMMARY Objective: Evaluation of the transforaminal epidural steroid injection for the treatment of lumbar disc herniation under computed tomography-guided Subject and method : 80 patients with lumbar disc herniation were diagnosed at 108 Central Military Hospital from June 2020 to June 2021. Longitudinal follow-up and prospective study Results : Location of transforaminal L3-L4 35%, L4-L5 58 %, L5S1 7%. VAS score before intervention, 1 day, 14 days, 1 month and 3 months after intervention were 6,48 ± 1,46; 3,21 ± 1,53; 2,74 ± 1,37; 2,55 ± 1,44; 2,75 ± 1,39 and ODI score before intervention, 1 day, 14 days, 1 month and 3 months after intervention were 59,26 ± 12,18; 35,68 ± 7,97; 33,63 ± 6,14; 30,18 ± 6,01; 28,15 ± 6,46. Statistically signficant difference Conclusion: Transforaminal epidural injection is an effective method of pain management and functional improvement for patients with lumbar disc herniation Keywords: Lumbar disc herniation, epidural injection, transforaminal

SUMMARY A Solitary Pulmonary Nodule (SPN) is a focal opacity on chest radiographs or CT with a clear border; at least partially covered by lung parenchyma; usually spherical; diameter equal to or less than 3 cm; can be solid (Solid Nodule – SN), Non-solid (Ground Glass Opacity – GGO) or Semi-solid (Part Solid – PS). One-third of lung cancers present as solitary masses or nodules and the majority are of the adenocarcinoma type. WHO's updated histopathological classification 2021, Adenocarcinoma is divided into the following types: Minimally Invasive Adenocarcinoma (MIA); Invasive Non-Mucinous Adenocarcinoma (INMA); Invasive Mucinous Adenocarcinoma (IMA); Colloid Adenocarcinoma (CA); Fetal Adenocarcinoma (FA) and Enteric Adenocarcinoma (EA). Minimally invasive adenocarcinoma (MIA) usually has the main characteristic components, which have Lepidic Predominant Adenocarcinoma (LPA). We report a case of LPA, PS type, was discovered incidentally, diagnosed, and operated at the National Lung Hospital, initially with excellent results. Keywords: Adenocarcinoma; Lepidic predominant adenocarcinoma; Minimally invasive adenocarcinoma; Lung cancer; Lung cancer staging

SUMMARY Superior vena cava syndrome often has a mediastinal malignant origin, although it is not commonly found in clinical practice. The cytology diagnosis of any mediastinal lesion is quite challenging because of the difficulty to perform any specimen collection procedure in such a location. Moreover, deep lesions that are surrounded by or have already invaded major blood vessels, make it even harder to perform a CT or Ultrasound-guided percutaneous biopsy, as well as increasing post-procedure complication risks. Therefore, mediastinoscopy is usually the first choice to collect samples whenever lesions are found in such areas, especially when surgical therapy is not recommended anymore. However, here, we performed a Forceps-supporting percutaneous endovascular biopsy on a deep mediastinal lesion, which invaded the superior vena cava-causing a superior vena cava syndrome. During the intervention, we also placed a covered stent to resolve the invasion-induced vena cava stenosis, which accomplished a diagnosis-treatment integration benefit, as the patient’s symptoms improved significantly afterward. The cytology result demonstrated a Diffuse Large B-cell Lymphoma, and our patient had his chemotherapy treatment started right away. Keywords: Endovascular biopsy, superior vena cava syndrome, covered stent