Quantification of Abdominal Fat in Obese and Healthy Adolescents Using 3 Tesla Magnetic Resonance Imaging and Free Software for Image Analysis.

BACKGROUND AND AIMS: Computed tomography, which uses ionizing radiation and expensive software packages for analysis of scans, can be used to quantify abdominal fat. The objective of this study is to measure abdominal fat with 3T MRI using free software for image analysis and to correlate these findings with anthropometric and laboratory parameters in adolescents. METHODS: This prospective observational study included 24 overweight/obese and 33 healthy adolescents (mean age 16.55 years). All participants underwent abdominal MRI exams. Visceral and subcutaneous fat area and percentage were correlated with anthropometric parameters, lipid profile, glucose metabolism, and insulin resistance. Student's t test and Mann-Whitney's test was applied. Pearson's chi-square test was used to compare proportions. To determine associations Pearson's linear correlation or Spearman's correlation were used. RESULTS: In both groups, waist circumference (WC) was associated with visceral fat area (P = 0.001 and P = 0.01 respectively), and triglycerides were associated with fat percentage (P = 0.046 and P = 0.071 respectively). In obese individuals, total cholesterol/HDL ratio was associated with visceral fat area (P = 0.03) and percentage (P = 0.09), and insulin and HOMA-IR were associated with visceral fat area (P = 0.001) and percentage (P = 0.005). CONCLUSIONS: 3T MRI can provide reliable and good quality images for quantification of visceral and subcutaneous fat by using a free software package. The results demonstrate that WC is a good predictor of visceral fat in obese adolescents and visceral fat area is associated with total cholesterol/HDL ratio, insulin and HOMA-IR.

Retalho tenar adipofascial reverso para cobertura do nervo mediano hipertrofiado em macrodactilia / The reverse adipofascial thenar flap for coverage of the hypertrophied median nerve in macrodactyly

A macrodactilia é uma anomalia congênita infrequente, caracterizada pelo crescimento desproporcional dos tecidos ósseo, gorduroso, nervoso, vascular e dérmico nos dedos das mãos ou dos pés. Existem muitas teorias sobre a sua etiopatogenia, sendo a mais aceita a hiperestimulação por fatores de crescimento enviados através dos nervos. Foram descritos alguns casos associados com a síndrome do túnel do carpo. Apresenta-se um caso clínico de síndrome do túnel do carpo por hipertrofia do nervo mediano, evidenciando um aumento de conteúdo dentro do retináculo flexor, o qual foi tratado cirurgicamente com sucesso pela realização de uma retinaculotomia do ligamento anular do carpo junto a um retalho de transposição tenar adipofascial reverso da região tenariana hipertrofiada visando à cobertura do nervo mediano na região do punho.

Macrodactyly is a rare congenital anomaly characterized by the disproportionate growth of bone, fat, nervous, vascular, and dermal tissue in the digits . There are many different theories about its etiopathogenesis, the most accepted being a hyperstimulation by growth factors conducted through nerves. A few cases have been described in conjunction with carpal tunnel syndrome. Here, a clinical case of carpal tunnel syndrome due to hypertrophy of the median nerve is presented, showing an increase of content within the flexor retinaculum. Successful surgical treatment was accomplished by conducting a retinaculotomy of the anterior annular ligament along with a reverse transposition adipofascial flap of the hypertrophied thenar region for coverage of the median nerve at the wrist.

Diagnóstico por imagem no abdome agudo não traumático / Diagnostic imaging in nontraumatic acute abdomen

O abdome agudo não traumático é uma síndrome clínica muito frequente na prática médica e que exige diagnóstico rápido e preciso para orientar a abordagem terapêutica mais adequada. Os exames de imagem tem fundamental importância no processo diagnóstico, sendo a radiologia convencional, a ultrassonografia e a tomografia computadorizada os exames mais utilizados.

The non-traumatic acute abdomen is a very common clinical syndrome in medical practice and requires rapid e accurate diagnosis to guide the most appropriate therapeutic approach. Imaging studies are essencial in the diagnosis process. Conventional radiography, ultrassonography and computed tomography are the most used.

Manejo da dislipidemia / Management of dyslipidemia

A escolha do tratamento e a tomada de decisões frente a um caso de dislipidemia dependem de vários fatores. Na prática clínica, por vezes, nos deparamos com situações em que o manejo ocorreu baseado apenas em exames laboratoriais isolados, em detrimento da análise cuidadosa dos fatores de risco do paciente. Nossa meta será expor de forma clara e objetiva como o médico deverá proceder em relação ao manejo da dislipidemia.

The choice of treatment in dyslipidemia depends on several factors. In clinical practice, sometimes we encounter situations where the management was based only on laboratory tests isolated at the expense of risk factors calculation. Our goal is to expose a clear and objective way the doctor will proceed with the management of dyslipidemia.

Intoxicação por anestésicos locais / Local anesthetics intoxication

Os autores discutem os principais pontos sobre a toxicidade dos anestésicos locais, os sinais e sintomas de intoxicação e princípios do manejo desses pacientes.

The authors discuss the main points about local anesthetics toxicity, intoxication signs and symptoms and principles of management of these patients.

Lesões ameaçadoras da vida no trauma torácico / Life threatening injuries in the thoracic trauma

Lesões do tórax respondem por aproximadamente 25% dos óbitos decorrentes de trauma, mas apesar do alto percentual de danos que acarretam, a maioria dos pacientes poderão ser satisfatoriamente tratados com procedimentos simples na sala de emergência. Nosso objeto neste capítulo é descrever, de forma resumida, as condições de maior risco e seus respectivos manejos.

Thoracic injuries count for approximately 25% of deaths due to trauma, and despite the high percentage of internal damage, most patients can be treated satisfactorily with simple procedures in the emergency room. Our objective in this chapter is to briefly describe these conditions and their management.