The somatostatin receptor subtype 2 is expressed on macrophages, an abundant cell type in the atherosclerotic plaque. Visualization of somatostatin receptor subtype 2, for oncologic purposes, is frequently made using the DOTA-derived somatostatin analogs DOTATOC or DOTATATE for PET. We aimed to compare the uptake of the PET tracers 68 Ga-DOTATOC and 64 Cu-DOTATATE in large arteries, in the assessment of atherosclerosis by noninvasive imaging technique, combining PET and CT. Further, the correlation of uptake and cardiovascular risk factors was investigated. Methods: Sixty consecutive patients with neuroendocrine tumors underwent both 68 Ga-DOTATOC and 64 Cu-DOTATATE PET/CT scans, in random order. For each scan, the maximum and mean standardized uptake values (SUVs) were calculated in 5 arterial segments. In addition, the blood-pool-corrected target-to-background ratio was calculated. Uptake of the tracers was correlated with cardiovascular risk factors collected from medical records. Results: We found detectable uptake of both tracers in all arterial segments studied. Uptake of 64 Cu-DOTATATE was significantly higher than 68 Ga-DOTATOC in the vascular regions both when calculated as maximum and mean uptake. There was a significant association between Framingham risk score and the overall maximum uptake of 64 Cu-DOTATATE using SUV (r 5 0.4; P 5 0.004) as well as target-to-background ratio (r 5 0.3; P 5 0.04), whereas no association was found with 68 Ga-DOTATOC. The association of risk factors and maximum SUV of 64 Cu-DOTATATE was found driven by body mass index, smoking, diabetes, and coronary calcium score (P , 0.001, P 5 0.01, P 5 0.005, and P 5 0.03, respectively). Conclusion: In a series of oncologic patients, vascular uptake of 68 Ga-DOTATOC and 64 Cu-DOTATATE was found, with highest uptake of the latter. Uptake of 64 Cu-DOTATATE, but not of 68 Ga-DOTATOC, was correlated with cardiovascular risk factors, suggesting a potential role for 64 Cu-DOTATATE in the assessment of atherosclerosis.

We found a low prevalence of PAD in HIV-infected patients. ABI did not correlate with CVD risk factors or cIMT. Based on these results ABI does not seem valuable as a screening tool for CVD among HIV-infected patients.

No abstract

Background: Fixation of posterior malleolar (PM) fragments remains a controversial topic in ankle fracture management. Our objective was to examine the incidence of severe adverse events (AEs) associated with surgical management of patients with ankle fractures involving the posterior malleolus before increased use of direct PM fragment fixation.Methods: This is a retrospective cohort study including patients from a level III trauma center in the Capital region of Denmark. Adult patients (age >18 years) with ankle fractures involving a PM fragment treated surgically with a minimum of 18 months follow-up were included. The main outcome measurements were adverse events (graded using the Orthopaedic Surgical Adverse Events Severity (OrthoSAVES) System) requiring revision in the first 12 months after surgery. Results: In 75 out of 421 included patients (17.8%), PM fragments were surgically fixed. During the first twelve months after surgery, 34 patients (8.1% (95% CI [5.9–11.1%])) experienced AEs requiring revision. 17 patients (4%) were revised due to deep infection, 10 patients (2.4%) due to malpositioned implants, and 3 patients (0.7%) due to postoperative loss of reduction. Additional causes of revision were impingement of intraarticular fragment, non-union, postoperative joint dislocation, and postoperative vascular insufficiency leading to transmetatarsal amputation. Conclusions: The incidence of AEs requiring revision within the first twelve months after surgery was 8.1%, and the overall risk of severe AEs seemed unacceptably high. If direct PM fragment fixation can decrease the risk of severe AEs, then a change of practice could be justified. Further prospective studies are needed to establish generalizability, safety and efficacy before direct PM fragment fixation can be recommended in clinical guidelines.

Background Recent systematic reviews support that non-operative management should be the standard treatment for all stable isolated lateral malleolar fractures (ILMFs), regardless of fibular fracture displacement. Surgical fixation of ILMFs carries a risk of adverse events (AEs), and many patients will later require implant removal. We wanted to estimate the incidence of AEs requiring revision after surgical fixation of “potentially stable” displaced ILMFs before non-operative treatment became standard care in our department. Materials and methods To identify patients with “potentially stable” ILMFs who had been treated surgically in a historical cohort, we retrospectively applied the stability-based classification system, introduced by Michelson et al., to a cohort of 1006 patients with ankle fractures treated surgically from 2011 to 2016. The primary outcome of this retrospective cohort study was the incidence of AEs that had functionally significant adverse effects on outcome and required revision in the first 12 months after surgery. AEs were graded and categorized using the Orthopedic Surgical Adverse Events Severity (OrthoSAVES) System. Results The study population comprised 108 patients with “potentially stable” displaced ILMFs; 4 patients (3.7% [95% CI (0.1–7.3%]) experienced AEs requiring revision in the first twelve months after surgery. There were 5 additional patients (4.6%) with functionally significant AEs where revision surgery was not indicated within the first twelve months after surgical fixation. A further 5 patients (4.6%) had AEs managed in the outpatient clinic (grade II); 36 patients (33.3%) required secondary implant removal due to implant-related discomfort. Conclusions Surgical fixation of ILMFs carries a risk of severe AEs, and many patients will subsequently need implant-removal procedures. Further prospective studies are required to ascertain whether non-operative treatment can lower the risk of AEs and the need for additional surgical procedures.