Physical performance measures in screening for reduced lean body mass in adult females with obesity.

BACKGROUND & AIMS: Little is known about the reduction of lean body mass (LBM) in obesity, or how to identify it in standard clinical settings. We therefore aimed to assess the prevalence of low LBM in adult females with obesity, and to identify the reliability of simple tools for its screening in this population. METHODS AND RESULTS: Dual-energy X-ray absorptiometry (DXA) body composition assessment was used to categorise 147 female participants with obesity as with or without low LBM, according to the new definition that takes into account both appendicular lean mass (ALM) and body mass index (BMI)-ALM/BMI <0.512. Participants were also administered the six-minute walking test, handgrip-strength test and 4-metre gait-speed test. Of the sample of 147 participants, 93 (63.3%) met the criteria for reduced LBM. Stepwise multivariate logistic regression analysis showed that the six-minute walking test was the only independent test associated with low LBM (OR = 0.992, 95%CI 0.987-0.998). Receiver operating characteristic (ROC) curve analysis found that the discriminating cut-off points of the tests considered were 470 m, 3.30 s (gait speed = 1.2 m/sec) and 23.5 kg respectively; the 4-metre gait-speed test seems to provide the best balance of sensitivity and specificity, and the greatest discriminatory power at 90% sensitivity. CONCLUSIONS: Treatment-seeking adult females with obesity display a great prevalence of reduced LBM. The six-minute walking test was the only independent test associated with low LBM, but the 4-metre gait-speed test seems to be the most accurate functional test for screening for this condition in that population.

Endorectal ileal pull-through for ulcerative colitis and polyposis in children.

The marked reluctance to leaving a permanent ileostomy in a child is understandable; too often, however, before surgical therapy is accepted, the patient is permitted to decline to a hopeless state from which restoration is virtually impossible without operation. Endorectal ileal pull-through provides an attractive alternative. From 1972 to 1982 at Children's Hospital, G. Gaslini Institute, Genoa, nine patients with ulcerative colitis and eight patients with familial polyposis received this operation. Results are encouraging and support the more frequent use of this alternative.

[Treatment with Soave's technic and long-term results in 270 cases of Hirschsprung disease]. / Tratamiento y resultados a largo plazo de 270 casos de enfermedad de Hirschsprung con la técnica de Soave.

The authors present the surgical technique for the correction of Hirschsprung disease following SOAVE's original description. A series of 270 cases observed in 20 years at the Pediatric Surgery Department of the "Instituto Giannina Gaslini" in Genova, Italy, are examined. These cases, all treated by surgery, were followed up in long term for more than one year both clinically and radiologically. Additionally 73 cases treated from 1977 on were also followed up with the aid of ano-rectal electro-manometry. The most recent diagnostic aspects are discussed, such as ano-manometry, and some conclusions are drawn about long term results.

Histochemical enzymatic assessment of the human appendix at different ages.

The appendectomy specimens submitted to surgical pathology exhibit a wide variety of morphological appearances. We have evaluated the activities of acid phosphatase, alpha-naphthyl esterase, and leucineaminopeptidase in 100 human appendixes divided into six age groups in order to ascertain whether any histochemical pattern was related to the age group rather than to pathological condition. Our findings support that the submucosal fibrosis is unrelated to the patient's age, as well as appendiceal obliteration. It is noteworthy that the mucosa of the appendix may retain its lymphoid constituents at any age and that young subjects may already show appearances of involution up to lumen obliteration.

Malignant mesenchymoma of the liver in children: a clinicopathologic and ultrastructural study.

A primary malignant mesenchymoma of the liver in a nine year old boy is reported with the results of ultrastructural investigation. In accordance with previous observations, our study indicates that this type of tumor is remarkable because of its bulky size and possible rapidly fatal outcome. Although the term malignant mesenchymoma can be applied, the tumor is primarily fibrosarcomatous and liposarcomatous. It could be postulated that this tumor and the more frequent benign mesenchymal hamartoma of the liver are two histogenetically related lesions that preferentially affect the liver in children.

Adenocarcinoma of the rectosigmoid colon in a 10-yr-old child.

The authors describe a case of adenocarcinoma of the rectum in a 10-yr-old boy. The clinical picture, the surgical technique, and the histology are described, an reference is made to the small number of similar cases appearing in the world literature.

Xanthogranulomatous lymphadenitis.

A case of an unusual type of granulomatous lymphadenitis, initially suspected of being a malignant lymphoma, is reported. Histologically, this lesion shows a striking xanthomatous appearance, due to collections of foamy histiocytes interspersed with chronic inflammatory cells, and resulting in a storage-like aspect. Evidence indicates that this process merely represents the reabsorption and healing phases of an acute suppurative lymphadenitis, with histopathologic features comparable to those of xanthogranulomatous pyelonephritis. The term xanthogranulomatous lymphadenitis is suggested for this previously inadequately described lesion, and the likely non-specific degenerative character of the xanthomatous response is stressed.

Retroperitoneal fibrohistiocytic tumors in children: report of five cases.

Five rare retroperitoneal fibrohistiocytic tumors of children are described mainly in reference to the pathological aspects. A more detailed description is given of a retroperitoneal xanthogranuloma, including an ultrastructural study. This case is particularly interesting for its rapid transformation into a fibroxanthosarcoma. The other cases include two fibroxanthosarcomas, a storiform fibrous xanthoma, and a malignant histiocytoma. The most difficult points in the recognition and in the differential diagnosis of these tumors are discussed, and emphasis is placed on some interesting pathological features. Prognosis of such tumors appears difficult to assess from our series since two patients died in the immediate postoperative period, one died one and a half years after the discovery of the tumor, and two are alive and well, but with a short follow-up.

Megacolon: long-term results of surgical treatment.

The 10-year follow-up results for operations for Hirschsprung's disease from 24 pediatric surgical clinics are reviewed. Some of the bad results achieved are probably due mainly to operative technical errors. Many of the problems occured rather early during the follow-up period.