As características morfológicas da placa aterosclerótica têm sido sugeridas como componentes auxiliares à estenose, na avaliação de risco de acidente vascular cerebral (AVC), em pacientes com doença aterosclerótica carotídea sintomática. O objetivo desse estudo foi comparar as características da placa aterosclerótica de carótida pelo método de tomografia computadorizada com a análise histológica. Foram incluídos 19 pacientes com doença carotídea sintomática submetidos à TC de placa carotídea antes da realização de endarterectomia carotídea. Uma comparação sistemática entre a TC e a histologia foi realizada para determinar a correspondência entre os componentes da placa seguindo a classificação da \"American Heart Association\". Foi considerada placa vulnerável o tipo VI. A histologia foi realizada 5 (±2) dias após a TC. Os laudos (radiologia e patologia) foram comparados pelo investigador principal. Foi dosada a proteína C-Reativa (PCR) sérica e realizada avaliação do desempenho do PCR para detectar placa vulnerável, considerando como padrão-ouro o resultado da avaliação histológica. Foi avaliada a relação entre PCR e o tempo entre o evento e a cirurgia. Para tipo de placa aterosclerótica, foi encontrada uma acurácia de 84,2% (IC 95%: 82,8% a 85,6%), da tomografia em relação à histologia. A concordância para identificar ruptura de capa fibrosa com acurácia 94,7% (IC 95%: 94,2% a 95,3%), e, para calcificação, com acurácia 89.5% (IC 95%: 88,5% a 90,5%), foi considerada alta, e moderada para identificar hemorragia (68% acurácia). A concordância é moderada entre PCR de alto risco e placa vulnerável, e não há relação entre PCR, placa vulnerável e tempo de cirurgia. A tomografia de placa carotídea é um bom método não invasivo para detecção de vulnerabilidade da placa, identificação de ruptura de capa fibrosa e calcificação. Na nossa amostra, a concordância entre PCR alto risco e vulnerabilidade foi moderada, e não observamos relação entre vulnerabilidade, PCR e tempo entre o evento e a endarterectomia / Plaque morphologic characteristics have been suggested as an auxiliary component to luminal narrowing for assessing the risk of stroke associated with carotid atherosclerotic disease (CAD). The purpose of this study was to evaluate the ability of CT angiography (CTA) to categorize carotid artery atherosclerotic plaques (CAP) features in symptomatic patients submitted to endarterectomy according to the AHA histological classification. Nineteen patients with symptomatic CAD who underwent carotid CTA before endarterectomy were enrolled in a prospective study. A systematic comparison of CTA images with histological sections was performed to determine the CT attenuation associated with each component of the CAP. Histologic examination was performed 5 ± 2 days after the CTA. The neuroradiologist\'s reading of these analyses was compared with the histological slides interpretation performed by the same pathologist according to the CAP features following the AHA classification. The type VI plaque was considered as complicated. The two experts were blinded to each other\"s assessments. We performed C reactive Protein (CRP) and the CRP capacity to detect plaque vulnerability, considering histologic features as gold standard and the relation between CRP and time (event-surgery). There was an overall 84.2% (CI 95%: 82.8% a 85.6%), accuracy agreement in CAP classification between CTA and histological analysis. (Tab.1) The agreement between these two methods for the presence of calcification (Tab.2) in the CAP (accuracy 89.5%), and for categorizing the rupture of fibrous cap (accuracy 94,7), was excellent. (Tab. 3). CTA is not a good method to detect hemorrhage (Tab.4). High-risk CRP had moderate power to predict \"complicated plaque\" (Tab. 4) even as high risk CRP + CTA (Tab.5), There are No relation between CRP, complicated plaque and event to surgery delay. (Tab.6) CTA is a non-invasive tool that may help neurologists to categorize CAP features and potentially predict the risk of ischemic stroke in symptomatic CAD patients, and CRP could not be a good marker to complicated carotid plaque

As características morfológicas da placa aterosclerótica têm sido sugeridas como componentes auxiliares à estenose, na avaliação de risco de acidente vascular cerebral (AVC), em pacientes com doença aterosclerótica carotídea sintomática. O objetivo desse estudo foi comparar as características da placa aterosclerótica de carótida pelo método de tomografia computadorizada com a análise histológica. Foram incluídos 19 pacientes com doença carotídea sintomática submetidos à TC de placa carotídea antes da realização de endarterectomia carotídea. Uma comparação sistemática entre a TC e a histologia foi realizada para determinar a correspondência entre os componentes da placa seguindo a classificação da \"American Heart Association\". Foi considerada placa vulnerável o tipo VI. A histologia foi realizada 5 (±2) dias após a TC. Os laudos (radiologia e patologia) foram comparados pelo investigador principal. Foi dosada a proteína C-Reativa (PCR) sérica e realizada avaliação do desempenho do PCR para detectar placa vulnerável, considerando como padrão-ouro o resultado da avaliação histológica. Foi avaliada a relação entre PCR e o tempo entre o evento e a cirurgia. Para tipo de placa aterosclerótica, foi encontrada uma acurácia de 84,2% (IC 95%: 82,8% a 85,6%), da tomografia em relação à histologia. A concordância para identificar ruptura de capa fibrosa com acurácia 94,7% (IC 95%: 94,2% a 95,3%), e, para calcificação, com acurácia 89.5% (IC 95%: 88,5% a 90,5%), foi considerada alta, e moderada para identificar hemorragia (68% acurácia). A concordância é moderada entre PCR de alto risco e placa vulnerável, e não há relação entre PCR, placa vulnerável e tempo de cirurgia. A tomografia de placa carotídea é um bom método não invasivo para detecção de vulnerabilidade da placa, identificação de ruptura de capa fibrosa e calcificação. Na nossa amostra, a concordância entre PCR alto risco e vulnerabilidade foi moderada, e não observamos relação entre vulnerabilidade, PCR e tempo entre o evento e a endarterectomia / Plaque morphologic characteristics have been suggested as an auxiliary component to luminal narrowing for assessing the risk of stroke associated with carotid atherosclerotic disease (CAD). The purpose of this study was to evaluate the ability of CT angiography (CTA) to categorize carotid artery atherosclerotic plaques (CAP) features in symptomatic patients submitted to endarterectomy according to the AHA histological classification. Nineteen patients with symptomatic CAD who underwent carotid CTA before endarterectomy were enrolled in a prospective study. A systematic comparison of CTA images with histological sections was performed to determine the CT attenuation associated with each component of the CAP. Histologic examination was performed 5 ± 2 days after the CTA. The neuroradiologist\'s reading of these analyses was compared with the histological slides interpretation performed by the same pathologist according to the CAP features following the AHA classification. The type VI plaque was considered as complicated. The two experts were blinded to each other\"s assessments. We performed C reactive Protein (CRP) and the CRP capacity to detect plaque vulnerability, considering histologic features as gold standard and the relation between CRP and time (event-surgery). There was an overall 84.2% (CI 95%: 82.8% a 85.6%), accuracy agreement in CAP classification between CTA and histological analysis. (Tab.1) The agreement between these two methods for the presence of calcification (Tab.2) in the CAP (accuracy 89.5%), and for categorizing the rupture of fibrous cap (accuracy 94,7), was excellent. (Tab. 3). CTA is not a good method to detect hemorrhage (Tab.4). High-risk CRP had moderate power to predict \"complicated plaque\" (Tab. 4) even as high risk CRP + CTA (Tab.5), There are No relation between CRP, complicated plaque and event to surgery delay. (Tab.6) CTA is a non-invasive tool that may help neurologists to categorize CAP features and potentially predict the risk of ischemic stroke in symptomatic CAD patients, and CRP could not be a good marker to complicated carotid plaque

Externe Fixateure werden häufig für die Stabilisierung und Behandlung schwerer Frakturen genutzt. Schraubenkanalinfektionen können dabei zu Komplikationen, wie Osteomyelitis und Stabilitätsverlusten führen. Es ist unklar, ob Schraubenkanalinfektionen zu Schraubenlockerungen führen, oder aber ob der Stabilitätsverlust von Schrauben in Schraubenkanalinfektionen resultiert. Das Ziel dieser Studie ist es, einen Zusammenhang zwischen der mechanischen Stabilität, dem Auftreten von Infektionen und der osseären Verankerung darzustellen. An 27 Schafen wurde eine standardisierte Osteotomie (3mm weiter Frakturspalt) der rechten Tibia durchgeführt und mit einem monolateralem Fixateur externe stabilisiert. Während der täglichen Pinpflege wurde die Haut um die Schraubeneintrittsstellen begutachtet. Radiologische Verlaufskontrollen erfolgten in wöchentlichen Abständen. Nach 3, 6 und 9 Wochen wurden die Tiere getötet, die Ausdrehmomente der Schrauben gemessen und mikrobiologische Abstriche genommen. Knochenschnitte durch die Schraubenkanäle wurden für histologische, histochemische und histomorphometrische Analysen genommen. In dieser Studie scheint es zu einer Zunahme der Stabilisierung der osseären Verankerung während des Heilungsverlaufes zu kommen. Da die kortikale Knochendichte über die Zeit abnimmt, kann die zunehmend stabilere Verankerung der Schrauben einzig über eine gleichzeitige periostale Kallusdichtezunahme erklärt werden. Die größten Ausdrehmomente des neugebildeten periostalen Kallus wurden zum Sechswochenzeitpunkt gemessen. Danach nimmt die periostale Kallusfläche ab, wohingegen die Kallusdichte zunimmt. Die mikrobiologische Besiedelungsrate (15%) war dreifach höher als die klinisch bestätigten Infektionen. Hingegen war die Osteolyserate (28%) doppelt so hoch wie die mikrobiologisch bestätigte Infektionsrate. Eine Korrelation zwischen Infektion, Osteolyse und Pinlockerung konnte nicht gefunden werden. / External fixators are frequently used for the stabilization and the treatment of problematic fractures. Pin track infections have been shown to cause complications such as osteomyelitis and loss of stability of osteosynthesis. It remains unclear, whether pin track infection provokes pin loosening, or loss of the pin stability results in pin track infections. The aim of this study was to investigate the correlation between the mechanical stability of pins, the incidence of pin track infections and the osseus anchorage of pins. 27 sheep underwent a standardized osteotomy (3 mm gap) of the right tibia. The tibiae were stabilized by a monolateral external fixator. Within the daily pin care routine, the skin around the pin entries was scored. Radiographs were taken at weekly intervals. After 3, 6 and 9 weeks, the animals were sacrificed, the extraction torque of all pins was determined and microbiological analyses were taken. Bone sections through the pintracks were taken for histological, histochemical and histomorphometrical analysis. This study reveals an increasing stability of osseous pinanchorage over the course of healing. As the cortical bone density decreased over time, the increased anchorage-stability of the pins can only be explained by the simultaneous increase of the periosteal callus bone density. The magnitude of the extraction force is determined by the newbuilt periosteal callus, which is at its biggest value at six weeks. Afterwards, the periosteal callus area abates, while the callus bone density accumulates. The microbiologically affirmed infection rate (15%) was three times higher than the one clinical ascertained. In contrast the evidence of osteolysis (28%) was twice as high as the microbiologically diagnosed infection-rate. Despite the low infection rate, evidence of cortical lysis coud not be prevented. No correlation could be found between infection, osteolysis and pin loosening.