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Asymptomatic renal carcinomas are usually small and localized and thus, for the assessment of pT, precise criteria are required, able to identify the initial phases of a local extension and correlate them with current prognostic prospects. Various studies and consensus meetings have defined precisely how to measure tumoral nodules (solid, cystic and multiple). Furthermore, they have distinguished tumoral extension to the renal sinus, which has a worse prognosis, from that to the perirenal adipose tissue. They have also analyzed the clinical significance of invasion of the sinus vessels, the hilar veins and parenchymal vascular retroinvasion. Our aim is to revise and update the criteria of the different pT subcategories and consider those morphological aspects which could be clinically significant and that are not currently included in the TNM classification., (Copyright © 2020 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.)

The majority of gastric neoplasms are of epithelial type. Stromal tumours are the next most frequent and are most commonly gastrointestinal stromal tumours, followed by leiomyoma and schwannoma. We present an exceptional case of a patient with a gastrointestinal stromal tumour with suspicion of residual gastric disease, which was diagnosed post-operatively as a schwannoma., (Copyright © 2018 Sociedad Española de Anatomía Patológica. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The objective of this study is to evaluate overall survival (OS), cancer-specific survival (CSS), relapse-free survival, local and distant (LRFS and DRFS, respectively) rates in patients with pT3a renal cell carcinoma (RCC) considering the perirenal and/or sinus fat infiltration (FI) as prognostic factors., Materials and Methods: Retrospective cohort of patients with pT3a RCC who underwent radical or partial nephrectomy. The data were extracted from the LARCG (Latin American Renal Cancer Group) database. The demographic, clinical, pathological and surgical variables were evaluated. FI was divided into 4 groups (vein, perirenal, sinus and both fats infiltration). The Kaplan Meier and Cox regression curves were performed., Results: 293 patients were included in the study. The mean age was 61.4 years. The median follow-up was 21 months (r: 1-194). CSS, RFS, LRFS and DRFS estimated at 3 years in the group of both fats' infiltration were 53.1, 45.1, 58.7 and 51.6 months, respectively, and always statistically lower than the rest (P˂0.005). In the multivariate analysis, the infiltration of both fats significantly increased specific mortality, overall and local relapse with respect to vein infiltration (HR: 4.5, 2.42 and 8.08, respectively). The Fuhrman grade and renal pelvis infiltration were independent predictors of CSS and RFS., Conclusions: Infiltration of both fats increases the risk of overall and local relapse in pT3a RCC. In the same way, it is associated with a lower cancer-specific survival and should be considered as a factor of poor prognosis., (Copyright © 2019 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: A simple and inexpensive method is required to assess fatty infiltration of the liver non-invasively., Aim: To develop and compare different methods to quantify liver fat by magnetic resonance and compare it against ultrasound., Material and Methods: Three algorithms were implemented: region growing (RG), graph cuts (GC) and hierarchical (HR), all based on the IDEAL method to obtain water and fat images. Using these images, the proton density fat fraction (PDFF) was calculated. The three methods were tested in phantoms with known fat percentages and later on we acquired images from 20 volunteers with an ultrasound diagnosis of fatty liver disease in different stages. For everyone, the PDFF of the nine liver segments was determined., Results: In phantoms, the mean error between the real fat percentage and the value obtained through the three methods was -1,26, -1 and -0,8 for RG, GC and HR, respectively. The hierarchical method was more precise and efficient to obtain PDFF. The results in volunteers revealed that ultrasound showed errors categorizing the severity of hepatic steatosis in more than 50% of volunteers., Conclusions: We developed a tool for magnetic resonance, which allows to quantify fat in the liver. This method is less operator dependent than ultrasound and describes the heterogeneity in the fat distribution along the nine hepatic segments.

Introduction and Objective: Epicardial fat has been associated with increased cardiovascular risk and the development of atherosclerosis. Transthoracic echocardiography provides a reliable measurement of epicardial fat thickness (EFT). The aim of this study is to evaluate the relationship between EFT and biochemical parameters of metabolic risk., Material and Method: We assessed 211 patients who underwent echocardiography; EFT was measured by two cardiologists. In addition, patients' glycaemia, lipid profile and serum uric acid were measured. Statistical analysis was performed with the Pearson coefficient test and Odds ratio., Results: A positive correlation between EFT with glycaemia (r=.064), total serum cholesterol (r=.0056), high density lipoproteins (r=-.038), or with triglycerides (r=.118) was not observed. However, we did find a significant positive correlation between EFT and serum uric acid (r=.415, P<.00001). The odds ratio for EFT>3mm in patients with hyperuricemia was 6.26 (IC 95 2.79-14, P<.0001)., Conclusion: Hyperuricemia is strongly associated with EFT in Mexican patients; EFT is a useful tool for global cardiovascular risk calculation., (Copyright © 2018 Elsevier España, S.L.U. All rights reserved.)

Objective: We discuss the influence that involvement of fat (perirenal, sinus) and vascular structures (renal vein, segmental veins) have on cancer-specific mortality (CSM) rates in renal cancer., Methods: We conducted a retrospective analysis of 140 stage pT3a kidney tumors (114 clear cell, 9 type I papillary, 6 type II papillary, 11 chromophobe) surgically treated between 1997 and 2015. We conducted a cancer-specific survival study (Kaplan Meier) and a univariate and multivariate analysis of the variables: perirenal fat invasion, sinus fat invasion, renal vein invasion, segmental vein invasion and Fuhrman grade., Results: With a mean follow-up of 79 months, 47 deaths occurred overall (31.7%), 29 of which were due to the kidney tumor (CSM 20%). There were 50 cases of vascular invasion (35.7%), 40 cases with fat only invasion (28.6%) and 50 cases with invasion of both (35.7%). In the survival study, fat invasion had the least impact (17%), and invasion of both (fat and vascular structures) had the worst survival (48% of total mortality). Vascular invasion represents 35% of the mortality rate. In the multivariate study, Fuhrman grade 3-4 (HR 10.7), renal vein invasion (HR 9.2) and concomitant vascular and fat invasion (HR 5.6) are the factors with the greatest impact., Conclusions: Tumor fat invasion has a lower impact on the CSM of kidney cancer than vascular invasion.

Background: Menopausal transition is critical for the development of early, subclinical vascular damage. Multiple factors, such as atherosclerosis, increased epicardial fat, and endothelial dysfunction can play a role. Hence, the objective of this study was the comparison of epicardial adipose tissue and carotid intima media thickness in order to establish the best predictor of carotid stiffness in middle-aged women with endothelial dysfunction., Methods: A total of 43 healthy women aged 40-59 years old with endothelial dysfunction previously demonstrated by flow mediated dilation were recruited to have anthropometric, biochemical, hormonal and ultrasound determinations of carotid intima media thickness and epicardial fat thickness., Results: Carotid arterial stiffness parameters (local pulse wave velocity [4.7±0.7 vs 4.8±0.5 vs 5.6±0.5m/s, respectively, p<0.001], pressure strain elastic modulus [55.2±13.4 vs 59.2±11.8 vs 81.9±15.6kPa, respectively, p<0.001], arterial stiffness index β [4.4±1.4 vs 5.0±1.1 vs 6.4±1.3, respectively, p<0.001]) and epicardial fat thickness (2.98±1.4 vs 3.28±1.9 vs 4.70±1.0mm, respectively, p=0.007) showed a significant and proportional increase in the group of late post-menopausal women when compared to early post-menopausal and pre-menopausal groups, respectively. Among body fat markers, epicardial fat was the strongest predictor of local pulse wave velocity, independent of age., Conclusions: In menopausal women with endothelial dysfunction, menopausal transition is associated with increased carotid arterial stiffness and epicardial fat thickness, independent of age. Ultrasound measured epicardial fat was a better independent predictor of arterial stiffness than carotid intima media thickness in these women., (Copyright © 2017 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

We describe a case of fat droplets and blood in the cerebral subarachnoid space secondary in a patient with a complex sacral fracture without associated cranial trauma, a few days after admission. To our knowledge, there is only one published case with similar findings and without any other underlying lesion as cause. We explain the differences in the mechanism of production between this direct fat embolism and brain fat embolism syndrome, which is an intravascular embolism with different radiological appearance. The most important features of sacral fracture with spondylopelvic dissociation are described. Finally, this entity should be taken into account in the differential diagnosis of the few causes of fat in the subarachnoid space. In the context of high-energy trauma fractures of the sacrum or spine must be ruled out as a potential cause of this uncommon intracranial finding., (Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

High weight is a protective factor against osteoporosis and risk of fracture. In obesity, however, where overweight is associated to excess fat, this relationship does not appear to be so clear, excess weight has sometimes been associated to decreased bone mass. Obesity interferes with bone metabolism through mechanical, hormonal, and inflammatory factors. These factors are closely related to weight, body composition, and dietary patterns of these patients. The net beneficial or harmful effect on bone mass or risk of fracture of the different components of this condition is not well known. We need to recognize patients at a greater risk of bone disease related to obesity to start an adequate intervention., (Copyright © 2016. Publicado por Elsevier España, S.L.U.)

Introduction: Circumstances such as gender, age, diabetes mellitus (DM) and renal failure impact on the body composition of patients. However, we use nutritional parameters such as lean and fat tissue with reference values from healthy subjects to assess the nutritional status of haemodialysis (HD) patients., Aims: To analyse body composition by bioimpedance spectroscopy (BIS) of 6395 HD patients in order to obtain reference values of lean tissue index (LTI) and fat tissue index (FTI) from HD patients; and to confirm its validity by showing that those patients with LTI below the 10th percentile calculated for their group have greatest risk of death., Material and Methods: We used the BIS to determine the LTI and FTI in our cohort of HD patients in Spain. We calculated the 10th percentile and 90th percentile of LTI and FTI in each age decile for patients grouped by gender and presence of DM. We collected clinical, laboratory and demographic parameters., Results: The LTI/FTI 10 and 90 percentile values varied by group (age, gender and presence of DM) and, after adjusting for other risk factors such as fluid overload, those patients with LTI lower than percentile 10 had a higher relative risk of death (OR 1.57) than those patients with higher values., Conclusions: Monitoring the LTI and FTI of patients on HD using suitable reference values may help to identify risk in this patient population., (Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.)

Obesity is a chronic disease with multiple origins. It is a widespread global phenomenon carrying potentially serious complications which requires a multidisciplinary approach due to the significant clinical repercussions and elevated health costs associated with the disease. The most recent evidence indicates that it shares a common characteristic with other prevalent, difficult-to-treat pathologies: chronic, low-grade inflammation which perpetuates the disease and is associated with multiple complications. The current interest in lipoinflammation or chronic inflammation associated with obesity derives from an understanding of the alterations and remodelling that occurs in the adipose tissue, with the participation of multiple factors and elements throughout the process. Recent research highlights the importance of some of these molecules, called pro-resolving mediators, as possible therapeutic targets in the treatment of obesity. This article reviews the evidence published on the mechanisms that regulate the adipose tissue remodelling process and lipoinflammation both in obesity and in the mediators that are directly involved in the appearance and resolution of the inflammatory process., (Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.)

Objective: To assess the relationship between primary hypothyroidism and subclinical atherosclerosis and its potential changes with L-thyroxine replacement therapy., Methods: A prospective cohort study including 101 patients with primary hypothyroidism and 101 euthyroid patients as controls was conducted from July 2011 to December 2013. Clinical, anthropometrical, biochemical, and ultrasonographic parameters were assessed at baseline and after one year of L-thyroxine replacement therapy., Results: At baseline, hypothyroid patients had significantly greater values of blood pressure, total cholesterol, VLDL cholesterol, left ventricular mass, epicardial fat, and carotid intima-media thickness as compared to controls. Total cholesterol, VLDL cholesterol, ventricular diastolic function, epicardial fat, carotid intima-media thickness, carotid local pulse wave velocity, pressure strain elastic modulus, and β arterial stiffness index showed a significant and positive correlation with TSH levels. After one year of replacement therapy, patients with hypothyroidism showed changes in total cholesterol, VLDL cholesterol, TSH, carotid intima-media thickness, and arterial stiffness parameters., Conclusions: Primary hypothyroidism is characterized by an increased cardiovascular risk. In these patients, L-thyroxine replacement therapy for one year is related to decreased dyslipidemia and improvement in markers of subclinical carotid atherosclerosis., (Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Preoperative staging of bladder cancer using imaging methods has serious limitations. The accuracy of the abdominal diffusion-weighted magnetic resonance (DW-MRI) to predict residual muscle invasion, perivesical and/or lymph node affectation in the cystectomy specimen is evaluated., Material and Methods: A prospective study was performed on 20 patients with high grade muscle invasive bladder cancer who received transurethral resection of the bladder (TURB) in a period of <1 month. The DW-MRI was performed before the radical cystectomy and the radiologist predicted muscle invasion, extravesical affectation and lymph node affectation, being blind to the histopathological study. Sensitivity (S), specificity (sp), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Ac) of the test were analyzed. The medians of the apparent diffusion coefficient (ADC) value (Mann-Whitney) were compared and the ROC curves study for DW-MRI and ADC was carried out., Results: Distribution by categories was: pT0 1(5%), pT1 6(30%), pT2 2(10%), pT3 8(40%) and pT4 3(15%). There was agreement in the T-pT assignment in 17(85%). In 7(35%) there was lymph node affectation (pN1-2). Consistency of the DW-MRI for muscle affectation was k=.89 (CI .67-1; S=1.0, Sp=,86, PPV=.93, NPV=1.0, Ac=.95), for perivesical fat affectation k=.6 (CI .25-.95; S=.8, Sp=.8, PPV=.8, NPV=.8, Ac=.8) and for lymph node affectation k=.89 (CI .67-1; S=.86, Sp=1.0, PPV=1.0, NPV=.93, Ac=.95). Mean value of ADC was greater in G2 tumors (OMS1987) compared to G3 (p=.08). Evaluation of DW-MRI imaging and ADC numerical value showed equivalent areas under the curve for muscle (.93 and .9; Z=.7), fat (.8 and .91; Z=.31) and lymph node (.93 and .97; Z=.36) affectation, respectively., Conclusions: DW-MRI allows for good pre-operative evaluation of the patient who is a candidate for cystectomy, especially for the prediction of muscle (

Obesity increases the risk of development of atherosclerosis. However, this risk significantly depends on adipose tissue distribution in the body and ectopic accumulation of visceral adipose tissue (VAT). Recent evidence suggests that each visceral fat deposit is anatomically and functionally different. Due to proximity to the organ, each visceral fat deposit exerts a local modulation rather than a systemic effect. Because of its unique location and biomolecular properties, a "non-traditional" fat depot - the epicardial adipose tissue - has been considered to play a causative role in atherosclerosis. Epicardial adipose tissue may be measured with imaging techniques and is clinically related to left ventricular mass, coronary artery disease, and metabolic syndrome. Therefore, epicardial fat measurement may play a role in stratification of cardiometabolic risk and may serve as a therapeutic target., (Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.)

The introduction of magnetic resonance imaging in spondyloarthritis constitutes the main improvement in imaging over the past two decades. X-rays remains the cornerstone of diagnosis, although magnetic resonance imaging is more sensitive in early stages of the disease. The primary advantage of magnetic resonance imaging is its ability to visualize soft tissue inflammation and inflammatory lesions within bone in three dimensions. Studies continue to appear describing its diagnostic utility, its sensitivity in early disease, its reliability, its predictive value for the detection of damage progression and its value in the assessment of certain complications. In this paper we review the characteristics of this imaging technique and the advantages and limitations of magnetic resonance imaging in spondyloarthritis., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Objective of the study is to review the current 7th edition of the TNM classification of renal tumors and to perform a critical analysis of the recent evidence in order to identify the limitations of this new staging system. A search of the english literature was performed through the Medline and Pubmed database using the following keywords: renal cell carcinoma, staging system and TNM. Overall, 2600 references were initially scrutinized. Forty papers were selected based on their pertinence with the topic of the review, level of evidence provided and overall contribution to the field. Few changes have been made in the current version of the TNM staging system of renal tumors. pT2 tumors have been divided in 2 subgroups based on tumor size with a cut-off at 10 cm; the invasion of the renal vein was classified as pT3a; finally, the invasion of the ispsilateral adrenal gland was classified as pT4. However, other changes were suggested by the analysis of the recent literature and have not been introduced in this new version. Further improvements of the TNM classification for renal tumors are needed especially with regard to locally advanced tumors and node-positive disease, in order to improve the accuracy of this important prognostic tool in renal oncology.

Objective: To assess the association between epicardial adipose tissue thickness (EAT) and plasma adrenomedullin plasma levels in patients with metabolic syndrome (MS)., Methods: Twenty-one patients (12 females and 9 males) with MS according to the International Diabetes Federation guidelines, aged 22-58 years, were enrolled into the study and compared to 19 age-matched control subjects without MS. Plasma glucose, lipid, and adrenomedullin levels were assessed. EAT, left ventricular mass, and carotid intima-media thickness were evaluated by transthoracic two-dimensional echocardiography., Results: No statistically significant differences were found between the groups in age, sex, and height. Body weight, abdominal circumference (AC), body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly higher (p=0.0001) in MS patients; this group also showed significantly higher glucose (p=0.001), total cholesterol (p=0.01), LDL-C (p=0.03), VLDL-C (p=0.005), triglyceride (p=0.002), Tg/HDL ratio (p=0.0001), and plasma adrenomedullin (3.49±1.21 vs 1.69±0.92 ng/mL; p=0.0001) levels and lower HDL-C (p=0.02) levels as compared to the control group. EAT was significantly thicker in MS patients compared to the control group (8.45±3.14 vs 5.43±0.96; p=0.0001), showed a positive correlation to BMI (r=0.347; p=0.02), AC (r=0.350; p=0.02), DBP (r=0.346; p=0.02), and adrenomedullin levels (r=0.741; p=0.0001). In multiple linear regression analysis, adrenomedullin was the only parameter associated to EAT (R(2)=0.550; p=0.0001)., Conclusion: In this small patient group, a statistically significant association was found between EAT and plasma adrenomedullin levels, which may be considered as a potential biomarker of MS., (Copyright © 2011 SEEN. Published by Elsevier Espana. All rights reserved.)

Introduction: Postmenopausal women have excess adiposity due to the lack of estrogens, which is related with an increase in the prevalence of metabolic syndrome (MS) risk factors. Few equations have been developed to measure body fat mass (FM) by bioelectric impedance (BIA) for Mexican women and none of the existing equations have been evaluated in Mexican postmenopausal women with MS., Material and Methods: We describe the association and agreement between two different BIA equations: NHANES III and Macias, et al. to estimate FM in 86 women (42-72 years old). Anthropometric and body composition measurements (BIA) were done in all women; FM was measured by densitometry (DXA). Mean differences by age group (< 55 years old and > or = 55 years old) (Student t test), correlations, simple linear regression models and agreement analysis (Bland-Altman method) were done., Results: The two equations showed underestimation of % FM compared to DXA. The equation that presents the greatest correlation and agreement with the gold standard is the NHANES equation, in both age groups., Conclusions: The NHANES equation is valid to estimate FM in Mexican postmenopausal women with MS. We recommend the use of this equation in the clinical practice.

Fat mass is the most variable component in the human body, both when comparing several individuals and when considering changes in the same person throughout life. Obesity is characterized by an excess of body fat that affects health and well-being of individuals. Risk associated with excess body fat is due, in part, to location of fat rather than to total amount. Today is stated that causes and metabolic consequences of regional distribution of fat are of particular clinical importance. To identify a compartment of morbid adipose tissue and to be able to act on it is one of the main aims of the present research. In this review, we have revised the existing literature on location and characteristics of total body fat in human adult. We have focused on abdominal region, basing this review on the use of modern imaging techniques available nowadays, such as computerized tomography and magnetic resonance imaging, with their advantages and limitations. The purpose of this review is to assess whether it is possible to know the body composition and fat distribution on the basis of image methods. Computed tomography technique was first applied in studies of obesity, but today, due to the inconvenience of irradiating the patient, this technique is being replaced by magnetic resonance that, in addition to avoid radiation, provides images of extraordinary quality. Both methods allow to subdivide the classic general fat depots in others more specific. Subcutaneous fat depot can be superficial or deep, while visceral can be divided in mesenteric, omental or epiploic, retroperitoneal and perirrenal fat. In addition, these modern techniques of imaging permit to study muscular fat, considered by some authors as the new fat compartment. Muscular fat includes fat located between skeletal muscle fibers, called extramyocellular fat, as well as lipids located within skeletal muscle fibers (intramyocellular fat). Its importance lies not only in size, similar to visceral fat, but on its pathophysiological implications. Finally, techniques of image analysis have prove to be extremely useful in studying the location and extent of abdominal fat compartments, becoming reference to validate equations obtained from the so-called "indirect methods".

Epidural fat is a reservoir of lipophilic substances that cushions the pulsatile movements of the dural sac, protects nerve structures, and facilitates the movement of the dural sac over the periosteum of the spinal canal during flexion and extension. Excessive epidural fat can compress the underlying structures, however, and affect the placement of catheters and the distribution of injected solutions. This review discusses changes in epidural fat related to various diseases and events: lipomatosis, epidural lymphoma, arachnoid cysts, epidural hematoma, meningiomas, angiolipomas, spondylolysis, scoliosis, spinal stenosis, and liposarcoma. Also discussed are the sequencing and protocols for magnetic resonance imaging that enable epidural fat to be observed and distinguished from neighboring structures. The relevance of epidural fat in spinal surgery is considered. Finally, we discuss the possible anesthetic implications of the abnormal deposition of epidural fat, to explain the unexpected complications that can arise during performance of epidural anesthesia.

The aim of this study was to determinate the performance of body mass index (BMI) for the diagnosis of obesity and as a predictor of body fatness in adult Chilean subjects. We conducted a study in 433 women (18-73 years old; BMI: 19.7 to 69.7 kg/m2) and 264 men (18-83 y.; BMI: 19.1 to 54.8 kg/m2). Bioelectrical resistance was measured by impedance method and fat mass percent (FM%) was calculated by fatness-specific equations developed by Segal et al. Obesity was defined as a BMI of at least 30 kg/m2. Increased fatness was defined by the FM% cut-off points of at least 25% for men and at least 30% for women. Sixty-four percent of women and 23.6% of men with BMI below 30 kg/m2 had FM% higher than 30% and 25%, respectively. A value of BMI of 26 kg/m2 in women and 30 kg/m2 in men had the best agreement to the cut-off points of fatness according to sensitivity vs. specificity analysis The following equations were developed to predict individual fatness: women FM% = 0.96 x BMI + 0.154 x age + 1.44 (r2 = 0.75; standard error 3.8%); men FM% = 0.99 x BMI + 0.141 x age - 9.914 (r2 = 0.66; standard error 4.4%). Differences between measured and predicted FM% presented a wide variation, with a range of +/- 2 sd of 7.5% in women and 8.8% in men. The commonly used value of BMI 330 kg/m2 as a cut-off point for obesity does not have adequate sensitivity and specificity for the screening of increased fatness subjects, specially in women. In this study BMI shows a low reliability as a predictor of individual body fatness, particularly in men and in subjects with a BMI below 30 kg/m2.

Introduction: The panniculitides or hypodermitis are a wide and heterogeneous group of diseases characterized by the presence of subcutaneous inflammatory nodules located generally in low limbs., Objectives: Show the clinicopathologic characteristics of the cases diagnosed as panniculitis for a 5 years period; their epidemiology, etiopathogenic factors, evolution and treatment., Material and Methods: A retrospective study of 113 patients diagnosed as panniculitis by histopathologic report of cutaneous biopsy since 1997 to 2001 were performed., Results: The sex proportion was of 4.65 women to every man. The mean age of these patients was 49 +/- 20 years old. 100% had legs affectation, 7.1% in arms, 5.9% in trunk and 0.9% in face. 9.7% presented fever and arthromyialgias, especially in young people (p < 0.05). The etiopathogenic factors implied were tuberculosis, streptococcic pharyngoamygdalitis, sarcoidosis and different drugs. The most frequent histological pattern was septal panniculitis without vasculitis. 24.8% did not realize any treatment; 32.5% took nonsteroideal anti-inflammatory drugs; 31.6% potassium iodide; 16% systemic corticosteroids and 7.1% tuberculostatic drugs. Evolution of the patients was good and independently from the treatment performed., Conclusions: Panniculitides are a group of diseases with similar clinic, but very heterogeneous in their etiology and histopathologic findings. They are more frequent in women and with more expressive clinic in young people. Up to in the 59.3% of the studied cases a causal etiologic agent was identified. These factors are compatible with the published ones in other previous panniculitis series. When a paniculitis is suspected, the most efficient tool is the clinical diagnosis. Histological confirmation by cutaneous biopsy it must be done when it is possible.

Abdominal obesity is associated with metabolic abnormalities, increasing the risk of type 2 diabetes and coronary artery disease (CAD). The Quebec Cardiovascular Survey demonstrated that the atherogenic metabolic triad (AMT) present in abdominally obese (AO) males increases the risk of CAD 20-fold over the course of 5 years. An early detection algorithm was developed to identify individuals presenting these atherogenic abnormalities. It was found that the association of large waist circumference (WC) and moderate hypertriglyceridemia (the "hypertriglyceridemic waist", or HW) could adequately identify a significant portion of individuals with the AMT. It is important to note that even in the absence of classic risk factors, abdominally obese patients can present increased risk of CAD if they have HW. Finally, it has been suggested that the risk of developing an acute coronary syndrome in AO patients is not always related to the degree of coronary stenosis, and the patient s atherothrombotic/inflammatory profile should be taken into account in evaluating risk. Stabilization of the atherosclerotic plaque would become a legitimate therapeutic objective, and more feasible for prevention of CAD, in AO patients.

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder of premenopausal women. These women have insulin resistance independent of obesity; and insulin resistance is now recognized as a risk factor for the development of type 2 diabetes mellitus, hypertension and cardiovascular disease., Purpose: We sought, therefore, to assess whether there was correlation between a simple fasting measure of insulin sensitivity (Homeostatic Model) and the Minimal-Model in this syndrome., Methods: Thirty-three PCOS women (aged 22.7 +/- 6.2 years and body mass index (BMI) 29.1 +/- 5.4) underwent frequently sampled i.v. glucose tolerance test (Minimal-Model)., Results: Seventeen patients (51.5%) had insulin sensitivity < 1.5 x 10(-4) min.-1.microU-1.mL-1. Patients with BMI > de 27 was more resistant than the BMI < or = de 27 (p = 0.004). The correlation in PCOS between Si (insulin sensitivity) and HOMA IR was found significant for all the group (p = 0.0001; RRANK = -0.76) and those women with BMI > de 27 (RRANK = -0.77; p = 0.00006), but not significant correlation was found in those with BMI < or = de 27 (RRANK = -0.43; p = 0.13)., Conclusions: We conclude that the HOMA IR may be useful as a screening test for insulin resistance in overweight and obese Mexican PCOS women but not in the lean ones.

The present study was conducted in order to analyze the relationship existing between leptin and insulin levels in massive weight loss and weight recovery. Thirteen patients with severe obesity, 14 patients with anorexia nervosa and 13 healthy control subjects were studied. The patients with severe obesity underwent a vertical banded gastroplasty followed by an 800 kcal/day diet for 12 weeks. They were evaluated prior to (body mass index [BMI] 51.2 +/- 8.8 Kg/m2) and after drastic weight loss (BMI 40.6 +/- 6.7 Kg/m2). Patients with anorexia nervosa were treated exclusively with nutritional therapy during 12 weeks, and they were evaluated at their lowest weight status (BMI 16.2 +/- 2.2 Kg/m2) and after weight recovery (BMI 17.9 +/- 2.3 Kg/m2). The BMI of the normal subjects was in the normal range of 20 to 27 Kg/m2 (average 22.8 +/- 2.6 Kg/m2). BMI, percentage of body fat, waist circumference, and serum levels of leptin, insulin, and C-peptide were determined in each patient and normal subject. In severely obese patients, serum leptin and insulin decreased significantly after drastic weight reduction (leptin: from 51.8 +/- 22.3 to 23.7 +/- 10.2 ng/ml; insulin: from 27.1 +/- 13.3 to 17.2 +/- 7.2 mU/ml). In patients with anorexia nervosa, the mean serum leptin levels were significantly higher after weight recovery (5.5 +/- 3.2 vs 7.6 +/- 6 ng/ml). Serum leptin in the severe obesity group correlated positively with BMI, percentage body fat and waist circumference before and after weight loss. In those patients suffering from anorexia nervosa, serum leptin correlated positively with the BMI, percentage of body fat, and waist circumference in the low weight state and after weight recovery. In addition, their serum insulin correlated with BMI and waist circumference after weight recovery. These data reveal that serum leptin concentration correlates significantly with the BMI and body fat content 1) in subjects with a range of weight and caloric intake, 2) in obese patients after drastic weight loss; 3) in anorexic patients after weight gain; and that hyper- or normoinsulinemia do not seem to have any influence on the leptin changes caused by weight loss or gain.

Introduction: Familial amyloidotic polyneuropathy type I is an hereditary autosomal dominant disease, characterized by having a mutant transthyretin (TTR met 30). For this reason there is a deposition of amyloid in several organs with their subsequent malfunction. The most characteristic clinical presentation is peripheral, sensomotor and autonomic neuropathy. The dysautonomic component is seen early and often dominates the clinical picture. Subsequently, there is cardiac, ocular or renal involvement and death generally occurs 10 to 15 years after onset of the disorder. In Portugal one thought the gene was fully penetrant and, thus, a positive family history was an important criterion for the diagnosis. However an increasing number of patients without a positive family history have been identified., Clinical Cases: We present the cases of three men and a woman, aged between 36 and 48 years, with clinical sensomotor and autonomic polyneuropathy. There was no known family history of the condition in any case. Nerve biopsy in three of the patients, and biopsy of abdominal fat in the other patient, showed amyloid to be present. Similarly, TTR met 30 analysis was positive in all cases, and allowed the diagnosis to be established., Conclusion: It is essential to do TTR met 30 analysis in all patients with peripheral polyneuropathy in whom there is obviously a dysautonomic component and no known family history.

Anthropometric changes in 53 premenopausal obese women, 25-45 year-old, after an obesity treatment, were analyzed. Before and immediately after treatment, midarm, abdomen, waist, hip, midthigh and midcalf circumferences, as well as tricipital, bicipital, suprailiac, subscapular, abdominal and calf skinfold thickness were measured. The later averaged over percentil 75th. All final measurements, except midcalf circumference, abdomen/waist and hip/midthigh indexes, were significantly lowers as compared with the initial values. Body weight decreased on average 8.9 kg, and skinfold thickness mean fell below the 75th percentile. Percentage body fat decreased 18.3%, and body mass index 11%. Initial principal component analysis results, exhibited three chief characteristics of obesity: general adiposity; trunk vs. extremity fatness, and upper vs. lower fatness. Body fat distribution pattern and body composition were modified as a result of the treatment. Therefore, the morbidity risk associated with them, was substantially reduced.

We report a 26 years old male with secondary amyloidosis and chronic renal failure who consulted due to a rapidly growing goiter associated with coarseness and dysphagia. Serum levels of thyroid hormones and TSH were normal and a neck CT scan showed a big mass in the anterior and lateral regions, that compressed neighboring structures. The patient was subjected to a total thyroidectomy and the pathological study revealed a diffuse fatty and amyloid infiltration of the thyroid gland. There was no evidence of malignancy.

Duchenne Muscular Dystrophy (DMD) is usually diagnosed several years after the onset of symptoms. The relatives of the patients with DMD frequently consult family physicians when they notice the first symptom. The purpose of this study was to determine the cause that influence the delayed diagnosis of DMD. Twenty-two patients with confirmed diagnosis of DMD were interviewed at two Neurology Centers (Mexican Social Security Institute) in Monterrey, Nuevo León, México. Two forms of onset of DMD: Retarded development and locomotion problems were found, confirming other studies. The mean age of onset of symptoms for 22 patients was 2.4 years. The mean age for DMD diagnosis was 4.9 years. Retarded development occurred in 12 (54.4%) of all cases and the age of diagnosis was between 1 and 6 years of age. In 10 cases of the group with locomotion problems (45.4%) the diagnosis was made between 3 and 11 years of age. The serum Creatine Kinase was increased in all patients and in the early stages these levels were much higher than late stages. Family physicians have opportunities to make early diagnosis of DMD if they are aware of the two forms of onset of the disease: Retarded development and locomotion problems and of the changes in serum CK levels. The findings of this study confirm the importance of family physicians in that respect and also in making recommendations for routine determination of serum Creatine Kinase (CK) as early as possible in a child with symptoms suggestive of DMD.

The aim of this work was to study the association between obesity and body fat distribution with known cardiovascular risk factors. Seven hundred eighty two healthy individuals, 634 men and 148 female age 44 +/- 10 years were studied. Multiple stepwise regression models were performed in which cardiovascular risk factors (total, LDL and HDL cholesterol, triglycerides, fasting and postprandial blood glucose, systolic and diastolic blood pressure) were considered as the dependent variable and age, sex, smoking habits, body mass index (BMI), waist circumference (WC), waist hip ratio (WHR), subscapular/tricipital skinfold ratio (STR) and percentage of total body fat (%BF), derived from the sum of four skinfolds, as the independent variables. Among anthropometric variables, WC was the principal predictor of total cholesterol and basal blood glucose, WHR was the principal predictor of HDL cholesterol (inverse relationship) and triglycerides; BMI was the principal predictor of systolic and diastolic blood pressure; %BF was the principal predictor of post prandial blood glucose. Performing the same analysis in a subgroup of patients with a BMI between 21 and 24, measures of fat distribution continued to be predictors of cardiovascular risk factors. It is concluded that both total body fat and its distribution are related to cardiovascular risk factors and, in some cases, may have an additive effect and should be measured in preventive medical examinations.

Obesity has been defined as excessive deposition of body fat tissue that risks the health and survival of the patient. It affects almost 30 per cent of whole population in western societies and it's also becoming a common problem in developing countries as rural areas are slowly decreasing in face of urban growing. In Mexico obesity affects as much as 28 per cent of the population of selected urban areas and the trend seems to follow the incidence in North America. There are genetic, environmental, physiological, psychological, social and cultural factors that determine or influence the presence of obesity in modern societies. To date the most accepted approach to the management of this problem lays on 3 main aspects: diet, exercise and behaviour modification. Pharmacological therapy should be limited to selected cases in which associated clinical risks warrant more urgent intervention. Surgical therapy is indicated for morbid obesity in which there is greater than 70 per cent excess weight. Prevention of obesity should remain one of the top priorities in public health and should take genetic, physiological, environmental, social, psychological, cultural and economic factors into consideration.

Purpose: To assess whether the variations in the number and size of the adipocytes are proportional, or not, to the changes of the fat tissue fraction (FF) associated to different degrees of hematopoietic cellularity of the bone-marrow., Material and Methods: The material was made up of 28 specimens of bone marrow biopsy, from which 265 microscopic fields representing a wide range of FF were obtained. As index of proportionality, the ratio N/S (adipocyte number/size) was employed., Results: The parameters FF and N/S showed a highly significant correlation (r = 0.89; p = 0.00000003) at low-normal FF range (< 40%), whereas at high FF range (> 40%), such a correlation was lacking (r = 0.01; p = 0.86)., Conclusion: At low-normal FF the adipocyte number and size vary proportionally. Conversely, at high FF, in some cases a more marked increase of number and in other instances of adipocyte size is detected. Further investigations are needed to find out the responsible factors for this different behaviour.

Purpose: To assess whether the variations in the number and size of the adipocytes are proportional, or not, to the changes of the fat tissue fraction (FF) associated to different degrees of hematopoietic cellularity of the bone-marrow., Material and Methods: The material was made up of 28 specimens of bone marrow biopsy, from which 265 microscopic fields representing a wide range of FF were obtained. As index of proportionality, the ratio N/S (adipocyte number/size) was employed., Results: The parameters FF and N/S showed a highly significant correlation (r = 0.89; p = 0.00000003) at low-normal FF range (< 40%), whereas at high FF range (> 40%), such a correlation was lacking (r = 0.01; p = 0.86)., Conclusion: At low-normal FF the adipocyte number and size vary proportionally. Conversely, at high FF, in some cases a more marked increase of number and in other instances of adipocyte size is detected. Further investigations are needed to find out the responsible factors for this different behaviour.

Purpose: 1) To analyze to what extent the fat tissue fraction of the human bone marrow with heterogeneous distribution depends on size and number of adipocytes. 2) To infer the influence of local factors on the two aforementioned parameters., Material and Methods: The material was made up of 15 specimens of bone marrow biopsy with markedly heterogeneous distribution of fat tissue, alternating normal or hyperplastic zones (area I) with aplastic ones (area II). The method of study was the stereological technique on plastic-embedded specimen sections., Results: In the area II, with a fat tissue fraction markedly higher than in area I, both adipocyte number and size were significatively increased. The fat tissue fraction difference (Dif FRGR) between both areas was significatively correlated with the difference of the adipocytes number (Dif Nv) but not of the size (Dif D). However, in multiple regression both Dif Nv and Dif D contributed significatively to Dif FRGR., Conclusions: Since the histopathological pattern investigated in this work represents a model caused by intervention of local factors, it can be concluded that these can modify both the size and number of adipocytes.

A 9 months old male with a lipomeningocele developed progressive flaccid paraparesis with loss of deep tendon reflexes and sensation to pink prick on the lower extremities. The clinical picture was secondary to a tethered spinal cord syndrome associated to the lipomeningocele. Surgical untethering of the spinal cord was followed by clinical recovery over a 3 months period.

The suprarenal myelolipoma is a myeloid tissue and fat tissue tumor. It can undergo degenerative processes of haemorrhage, necrosis and calcification. The diagnostic key is based on the finding of fat tissue in the inside of a suprarenal mass. A CAT would be the method allowing a more accurate diagnosis. Its limitations came from the presence of myelolipomas with abundant myeloid tissue, or which have suffered major degenerative processes in which it is difficult to identify the fat tissue, and in large retroperitoneal masses in which it is impossible to recognize their suprarenal origin.