A propósito de un caso de lipoma retroperitoneal / Retroperitoneal Lipoma: A case report

Los lipomas retroperitoneales son infrecuentes y suelen representar el 2.9% de los tumores primarios de origen en retroperitoneo1 . Pueden alcanzar gran tamaño y el diagnóstico diferencial debe hacer con el liposarcoma bien diferenciado, aunque es muy difícil de realizar en el preoperatorio2 . Se presenta el caso de un paciente con lipoma retroperitoneal cuyo diagnóstico se realizó por tomografía axial computada (TAC) y que fue extirpado en su totalidad.

Retroperitoneal lipomas are infrequent and can represent a 2.9 % of the primary tumors originated in the retroperitoneum. They can reach a great size and the differential diagnosis must be performed with the well differentiated liposarcoma, even though it is very difficult to establish it during the preoperative time. We describe herein a case of a patient with a retroperitoneal lipoma. The diagnosis was established with a computed axial tomography (CAT) and it was totally surgically removed.

Índice cintura-estatura como indicador de riesgo metabólico en niños / Waist-to-height ratio is an indicator of metabolic risk in children

Introducción La grasa abdominal, especialmente la visceral, está asociada con un riesgo alto de complicaciones metabólicas. El índice cintura-estatura es usado para evaluar grasa abdominal en individuos de todas las edades. Objetivo Identificar la capacidad del índice cintura-estatura (ICE) para detectar riesgo metabólico en niños mexicanos de edad escolar. Pacientes y método Se estudiaron niños entre 6 y 12 años. Se diagnosticó obesidad con un índice de masa corporal (IMC) ≥ percentil 85, y obesidad abdominal con ICE ≥0,5. Se midieron niveles sanguíneos de glucosa, colesterol y triglicéridos. Se determinó sensibilidad, especificidad, valor predictivo positivo y negativo, área bajo la curva, coeficiente de verosimilitud positivo y negativo de la RCE e IMC para identificar alteraciones metabólicas. Se compararon ICE e IMC para determinar cuál tiene mejor eficiencia diagnóstica. Resultados Se estudiaron 223 niños, 51 presentaron hipertrigliceridemia, 27 hipercolesterolemia y 9 hiperglucemia. Comparando la eficiencia diagnóstica del ICE contra el IMC se encontró sensibilidad del 100 vs.56% para hiperglucemia, del 93% contra 70% para hipercolesterolemia y del 76% contra 59% para hipertrigliceridemia, especificidad, valor predictivo negativo, valor predictivo positivo, coeficiente de verosimilitud positivo, coeficiente de verosimilitud negativo y área bajo la curva fueron superiores para ICE. Conclusiones El ICE es un indicador más eficiente que el IMC para identificar riesgo metabólico en niños mexicanos de edad escolar.

Introduction Abdominal fat, particularly visceral, is associated with a high risk of metabolic complications. The waist-height ratio (WHtR) is used to assess abdominal fat in individuals of all ages. Objective To determine the ability of the waist-to-height ratio to detect metabolic risk in mexican schoolchildren. Patients and Method A study was conducted on children between 6 and 12 years. Obesity was diagnosed as a body mass index (BMI) ≥ 85th percentile, and an ICE ≥0.5 was considered abdominal obesity. Blood levels of glucose, cholesterol and triglycerides were measured. The sensitivity, specificity, positive predictive and negative value, area under curve, the positive likelihood ratio and negative likelihood ratio of the WHtR and BMI were calculated in order to identify metabolic alterations. WHtR and BMI were compared to determine which had the best diagnostic efficiency. Results Of the 223 children included in the study, 51 had hypertriglyceridaemia, 27 with hypercholesterolaemia, and 9 with hyperglycaemia. On comparing the diagnostic efficiency of WHtR with that of BMI, there was a sensitivity of 100% vs. 56% for hyperglycaemia, 93 vs. 70% for cholesterol, and 76 vs. 59% for hypertriglyceridaemia. The specificity, negative predictive value, positive predictive value, positive likelihood ratio, negative likelihood ratio, and area under curve were also higher for WHtR. Conclusions The WHtR is a more efficient indicator than BMI in identifying metabolic risk in mexican school-age.

Imaging Findings of Common Benign Renal Tumors in the Era of Small Renal Masses: Differential Diagnosis from Small Renal Cell Carcinoma: Current Status and Future Perspectives

The prevalence of small renal masses (SRM) has risen, paralleling the increased usage of cross-sectional imaging. A large proportion of these SRMs are not malignant, and do not require invasive treatment such as nephrectomy. Therefore, differentation between early renal cell carcinoma (RCC) and benign SRM is critical to achieve proper management. This article reviews the radiological features of benign SRMs, with focus on two of the most common benign entities, angiomyolipoma and oncocytoma, in terms of their common imaging findings and differential features from RCC. Furthermore, the role of percutaneous biopsy is discussed as imaging is yet imperfect, therefore necessitating biopsy in certain circumstances to confirm the benignity of SRMs.

Tabagismo e obesidade abdominal em doadores de sangue / Smoking and abdominal fat in blood donors

OBJETIVO: Analisar a associação entre tabagismo e obesidade abdominal em doadores de sangue. MÉTODOS: Estudo de corte transversal com 1.235 homens adultos doadores de sangue (idade: 20-59 anos) em Cuiabá (MT). Foram coletados dados socioeconômicos, demográficos e antropométricos, bem como informações sobre o estilo de vida dos participantes. Neste estudo, a circunferência da cintura e a relação cintura/quadril foram utilizadas como marcadores de obesidade abdominal. A associação desses dois marcadores com o tabagismo foi analisada por meio de regressão linear múltipla em modelos distintos, ajustados para potenciais fatores de confusão. RESULTADOS: Dos 1.235 entrevistados, 273 (22,1%) declararam ser fumantes e, desses, 99 (36,3%) relataram fumar mais de 15 cigarros por dia. A média do índice de massa corpórea nos fumantes foi menor que nos não fumantes (p < 0,001). Nas análises de regressão linear múltipla, o tabagismo mostrou-se associado à circunferência da cintura e à relação cintura/quadril em fumantes de 6-10 cigarros/dia e de > 11 cigarros/dia. CONCLUSÕES: Nesta amostra, o tabagismo associou-se positivamente com indicadores de obesidade abdominal, independentemente de potenciais fatores de confusão, inclusive o consumo de bebidas alcoólicas.

OBJECTIVE: To assess the association between smoking and abdominal fat among male blood donors. METHODS: This was a cross-sectional study involving 1,235 adult male blood donors (age, 20-59 years) in the city of Cuiabá, Brazil. Socioeconomic, demographic, and anthropometric data, as well as information on the lifestyle of the participants, were collected. In this study, waist circumference and waist-to-hip ratio were used as markers of abdominal fat. The association between these two markers and smoking was analyzed by multiple linear regression in separate models, adjusted for potential confounders. RESULTS: Of the 1,235 respondents, 273 (22.1%) reported being smokers, and, of those, 99 (36.3%) reported smoking more than 15 cigarettes per day. The average body mass index was lower among smokers than among nonsmokers (p < 0.001). In the multiple linear regression analyses, smoking was associated with waist circumference and waist-to-hip ratio for smokers of 6-10 cigarettes/day and of > 11 cigarettes/day. CONCLUSIONS: In our sample, smoking was positively associated with indicators of abdominal fat, regardless of potential confounding factors, including the consumption of alcoholic beverages.

Evaluation of Portal Venous Velocity with Doppler Ultrasound in Patients with Nonalcoholic Fatty Liver Disease

PURPOSE: We examined the relationship between portal venous velocity and hepatic-abdominal fat in patients with nonalcoholic fatty liver disease (NAFLD), using spectral Doppler ultrasonography (US) and magnetic resonance imaging (MRI). MATERIALS AND METHODS: In this prospective study, 35 patients with NAFLD and 29 normal healthy adults (control group) underwent portal Doppler US. The severity of hepatic steatosis in patients with NAFLD was assessed by MRI through chemical shift imaging, using a modification of the Dixon method. Abdominal (intra-abdominal and subcutaneous) fat was measured by MRI. RESULTS: The difference in portal venous velocity between the patients with NAFLD and the control group was significant (p 0.05). There were strong correlations between the hepatic fat fraction and subcutaneous adiposity (p < 0.0001), intraperitoneal fat accumulation (p = 0.017), and retroperitoneal fat accumulation (p < 0.0001). CONCLUSION: Our findings suggest that patients with NAFLD have lower portal venous velocities than normal healthy subjects.

The Differential Imaging Features of Fat-Containing Tumors in the Peritoneal Cavity and Retroperitoneum: the Radiologic-Pathologic Correlation

There are a variety of fat-containing lesions that can arise in the intraperitoneal cavity and retroperitoneal space. Some of these fat-containing lesions, such as liposarcoma and retroperitoneal teratoma, have to be resected, although resection can be deferred for others, such as adrenal adenoma, myelolipoma, angiomyolipoma, ovarian teratoma, and lipoma, until the lesions become large or symptomatic. The third group tumors (i.e., mesenteric panniculitis and pseudolipoma of Glisson's capsule) require medical treatment or no treatment at all. Identifying factors such as whether the fat is macroscopic or microscopic within the lesion, the origin of the lesions, and the presence of combined calcification is important for narrowing the differential diagnosis. The development and wide-spread use of modern imaging modalities make identification of these factors easier so narrowing the differential diagnosis is possible. At the same time, lesions that do not require immediate treatment are being incidentally found at an increasing rate with these same imaging techniques. Thus, the questions about the treatment methods have become increasingly important. Classifying lesions in terms of the necessity of performing surgical treatment can provide important information to clinicians, and this is the one of a radiologist's key responsibilities.

Influência da adiposidade global e da adiposidade abdominal nos níveis de proteína C-reativa em mulheres idosas / Influence of overall and abdominal adiposity on C-reactive protein levels in elderly women

OBJETIVO: Examinar como a adiposidade global e a adiposidade abdominal, expressas pela circunferência da cintura (CC), pelo índice de massa corporal (IMC) e pelo somatório de dobras cutâneas (sigmaDC), influenciam os níveis de proteína C-reativa (PCR) em mulheres idosas. MÉTODOS: A amostra foi composta por 387 mulheres idosas, com idade superior a 60 anos (média, 68,9; desvio padrão, 5,9 anos). Foram avaliados o IMC, a CC, o sigmaDC, e os níveis de PCR. Foi utilizada a análise estatística ANOVA one-way para verificar as diferenças nas variáveis entre as categorias investigadas. Para avaliar a influência das medidas de adiposidade nos níveis de PCR foi utilizada a regressão logística. O nível de significância adotado foi de p < 0,05. RESULTADOS: A análise de variância demonstrou que o valor médio da CC foi menor na categoria normal de PCR, quando comparada aos níveis elevados de PCR. A regressão logística analisou a influência dos quartis do IMC, da CC e do sigmaDC nos níveis de PCR, em que apenas a CC foi preditora de níveis elevados de PCR, tendo o quartil extremo superior (ponto de corte de 94,0 cm) apresentado níveis quase duas vezes maiores que o quartil extremo inferior (risco estimado = 2,23; intervalo de confiança de 95 por cento = 1,92-4,18; p = 0,012). CONCLUSÃO: Os resultados do presente estudo apontam que a adiposidade abdominal é um forte preditor de níveis elevados de PCR.

OBJECTIVE: To investigate how overall and abdominal adiposity, measured by waist circumference (WC), body mass index (BMI), and sum of skinfolds (sigmaSK), affect plasma C-reactive protein levels (CRP) in elderly women. METHODS: Study sample consisted of 387 women older than 60 years (mean age 68.9; standard deviation 5.9 years). BMI, WC, sigmaSK, and CRP levels were all measured. One-way ANOVA was performed to detect differences in study variables among the CRP levels investigated. Logistic regression analysis was used to determine the influence of body fat measurements on CRP levels. The significance level was set at p < 0.05. RESULTS: The analysis of variance showed that mean WC was lower in women with normal CRP levels, as compared to those with high CRP levels. Logistic regression analysis examined the influence of BMI, WC, and sigmaSK quartiles on CRP levels, yielding the following results: only WC was predictive of elevated CRP levels, its highest quartile (cut-off point of 94.0 cm) showing levels nearly two times higher than its lowest quartile (odds ratio = 2.23; 95 percent confidence interval = 1.92-4.18; p = 0.012). CONCLUSION: The results of this study indicate that abdominal adiposity is a strong predictor of elevated CRP levels.

Potbelly--the most powerful predictor of metabolic syndrome and premature morbidity and mortality.

BACKGROUND: We evaluated the hospital population for the prevalence of the metabolic syndrome with the help of clinical variables, such as abdominal waist circumference, biochemical variables and ultrasonic variables. The aim was to define the most sensitive and powerful predictor of the syndrome, as also of premature morbidity and mortality. METHODS: We used clinical and biochemical data from our prospective study: "To Evaluate the Scenario of Metabolic Syndrome in the Hospital-Based Community". The criteria used for the definition of the syndrome were those laid down by the National Cholesterol Eradication Program Adult Treatment Panel III. The modified criteria for Asian Indians, that is, an abdominal waist circumference of greater than 90 cm in men, and above 80 cm in women, were also included. A total of 200 patients (100 males and 100 females) between the ages of 20 and 85 years were clinically and biochemically evaluated for the study. RESULTS: The results using the National Cholesterol Eradication Program Adult Treatment Panel III criteria as well as the modified criteria showed that abdominal waist circumference is the single most accurate (79% and 86.5%, respectively) predictor for determining the metabolic status of an individual (p-value <0.001). The waist circumference cut-off of the modified criteria proved to be a more accurate predictor for males as well as females (69% vs. 84%, and 89% vs. 85%, respectively for the two definitions; p-value <0.001). CONCLUSIONS: An abdominal girth of above 90 cm in males and above 80 cm in females is a far more powerful clinical predictor of the metabolic syndrome than other clinical, biochemical and ultrasonic variables (p-value <0.001). This may be considered in the context of premature morbidity and mortality.