Ultrasonic tissue characterization of vulnerable carotid plaque: correlation between videodensitometric method and histological examination

BACKGROUND: To establish the correlation between quantitative analysis based on B-mode ultrasound images of vulnerable carotid plaque and histological examination of the surgically removed plaque, on the basis of a videodensitometric digital texture characterization. METHODS: Twenty-five patients (18 males, mean age 67 ± 6.9 years) admitted for carotid endarterectomy for extracranial high-grade internal carotid artery stenosis (≥ 70% luminal narrowing) underwent to quantitative ultrasonic tissue characterization of carotid plaque before surgery. A computer software (Carotid Plaque Analysis Software) was developed to perform the videodensitometric analysis. The patients were divided into 2 groups according to symptomatology (group I, 15 symptomatic patients; and group II, 10 patients asymptomatic). Tissue specimens were analysed for lipid, fibromuscular tissue and calcium. RESULTS: The first order statistic parameter mean gray level was able to distinguish the groups I and II (p = 0.04). The second order parameter energy also was able to distinguish the groups (p = 0,02). A histological correlation showed a tendency of mean gray level to have progressively greater values from specimens with < 50% to >75% of fibrosis. CONCLUSION: Videodensitometric computer analysis of scan images may be used to identify vulnerable and potentially unstable lipid-rich carotid plaques, which are less echogenic in density than stable or asymptomatic, more densely fibrotic plaques

Bovine Peritoneum Protection Role on Intestinal Adhesions to a Vascular Graft: A Morphological Analysis

The present study aimed to experimentally evaluate the protection role of glycerin preserved bovine peritoneum (BP) against intestinal adhesions to a vascular graft. Experiments were performed on 24 adult rabbits, randomly dived into two groups. All animals were submitted to a vascular graft over the infra-renal aorta and vena cava. Group I (12 animals) was submitted to a BP patch on the retroperitoneal opening, between the vascular prosthetic graft and the intestinal loops. Group II (12 animals) had the retroperitoneal opening sutured. After 7, 14, 28 and 60 days, 3 animals of each group were randomly killed and the retro peritoneum, with or without the BP patch, was removed for histological analysis. The histological analysis showed that the BP stimulated a moderate to intense inflammatory reaction at the beginning of the experiments and on the 60-day evaluation, the inflammatory reaction was mild, limited to the BP border with its histological structure preserved. In conclusion, the BP is a safe and cheap interposition material to be used between vascular grafts and intestinal loops, presenting a protection role against adhesions between them.FAPESP[04/09139-2]FAPESP[06/03200-7]CNPq[303802/2006-5]CNPq[306452/2006-5

Tratamento cirúrgico e endovascular da hipertensão renovascular. Análise de 20 casos Surgical and endovascular treatment for renovascular hypertension. Analysis of 20 cases

O tratamento cirúrgico e endovascular da hipertensão renovascular (HRV) visa desobstruir a artéria renal, reverter a hipertensão arterial e preservar a função dos rins. O objetivo deste estudo foi verificar a resposta clínica de 18 pacientes com HRV submetidos a 8 procedimentos de revascularização cirúrgica e 12 de angioplastia transluminal percutânea (ATP) de artéria renal, no período de outubro de 1987 a junho de 1998, na Divisão de Cirurgia Vascular da FMRP-USP. Foram comparados dados clínico-laboratoriais (pressão arterial, creatinina plasmática, número de drogas anti-hipertensivas) no período pré-operatório e pós-operatório (2 e 7 meses após os procedimentos). Observou-se, nos 2 grupos de pacientes diminuição do número de drogas anti-hipertensivas utilizadas e manutenção dos valores de pressão arterial e de creatinina comparando-se os valores pós-operatórios com os pré-operatórios. No grupo ATP, 11 casos possuíam seguimento pós-cirúrgico, destes, 1 apresentou cura e 7 apresentaram melhora (72,7%) e 3 permaneceram inalterados (27,3%). Entre os 8 pacientes submetidos a revascularização cirúrgica, houve melhora em 7 casos (87,5%) e em 1 paciente (12,5%) não houve alteração do quadro. A revascularização cirúrgica ou endovascular possibilitou a diminuição da quantidade de medicamentos necessários para o controle da HA, mostrando-se eficaz no tratamento da HRV, com resultados comparáveis aos encontrados na literatura