Hepatic fat and abdominal adiposity in early pregnancy together predict impaired glucose homeostasis in mid-pregnancy.

Hepatic fat and abdominal adiposity individually reflect insulin resistance, but their combined effect on glucose homeostasis in mid-pregnancy is unknown. A cohort of 476 pregnant women prospectively underwent sonographic assessment of hepatic fat and visceral (VAT) and total (TAT) adipose tissue at 11-14 weeks' gestation. Logistic regression was used to assess the relation between the presence of maternal hepatic fat and/or the upper quartile (Q) of either VAT or TAT and the odds of developing the composite outcome of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or gestational diabetes mellitus at 24-28 weeks' gestation, based on a 75 g OGTT. Upon adjusting for maternal age, ethnicity, family history of DM and body mass index (BMI), the co-presence of hepatic fat and quartile 4 (Q4) of VAT (adjusted odds ratio (aOR) 6.5, 95% CI: 2.3-18.5) or hepatic fat and Q4 of TAT (aOR 7.8 95% CI 2.8-21.7) were each associated with the composite outcome, relative to women with neither sonographic feature. First-trimester sonographic evidence of maternal hepatic fat and abdominal adiposity may independently predict the development of impaired glucose homeostasis and GDM in mid-pregnancy.

An observational cohort study of the management and outcomes of vascular trauma.

OBJECTIVES: To evaluate aetiology, presentation, management and mortality following iatrogenic and non-iatrogenic vascular trauma in a regional vascular centre. METHODS: Retrospective observational cohort study of patients presenting with vascular trauma during a seven year period between January 2000 and December 2006. RESULTS: 182 cases of vascular trauma were identified (averaging 26 cases p.a.). The majority (n=132, 73%) were iatrogenic and tended to occur in patients aged >45 years, while 50 (27%) were penetrating/blunt, non-iatrogenic and predominantly occurred in younger males. The majority of iatrogenic vascular injuries (80/132) (61%) followed a cardiac intervention (angiography n=56, angioplasty n=23, pacemaker insertion n=1) and are now increasingly treated by non-operative therapies (thrombin, coils and covered stents). Overall, non-iatrogenic vascular trauma was associated with 4% mortality, compared with 7% following iatrogenic injury. However, while iatrogenic trauma of cardiological origin was associated with a mortality of only 1.3% (1/80), iatrogenic trauma of non-cardiological origin incurred a mortality of 17% (9/52). CONCLUSIONS: The commonest cause of vascular trauma (and with the lowest mortality rate) was cardiological related iatrogenic injury. However, while non-cardiological iatrogenic injury occurred with the same incidence as penetrating/blunt trauma, it was associated with a fourfold excess mortality.

Recurrent rectal tumour: localization using CT-guided percutaneous 'breast coil' placement prior to surgery.

A 58-year-old man presented with rectal tumour recurrence 5 years following abdomino-perineal resection for rectal cancer. As the recurrent lesion was small and surrounded by fibrotic tissue, it was felt necessary to localize the lesion prior to surgery. We describe the use of percutaneous CT-guided breast localization coil placement using a transgluteal approach for the pre-operative localization of such lesions in order to facilitate surgical removal.

Factors affecting patency of subintimal infrainguinal angioplasty in patients with critical lower limb ischemia.

BACKGROUND: Because subintimal angioplasty (SA) is a technique that can achieve recanalization of long arterial occlusions, it is considered an alternative to lower limb bypass operations. The aim of this prospective study was to identify the risk factors that affect patency of SA in patients suffering from critical limb ischemia (CLI). METHODS AND RESULTS: 51 consecutive infrainguinal SA were done in 46 patients suffered from CLI. The patients were followed-up with regular duplex scans up to 12 months post-intervention. Sex, atherosclerosis risk factors, and some technical details of the procedure (number of patent run-off vessels after the procedure, length and re-entry point of angioplasty) were examined as potential risk factors of patency, using survival analysis statistical techniques. The overall patency rate at 12 months post-intervention was 50%. According to Cox-regression analysis, the factors that affect patency were the number of run-off vessels and the length of occlusion. Patients with two or three run-off vessels had a hazard of occlusion of 0.30 (P = .027) compared to those who had one run-off vessel. The 12-months patency in patients with more than one run-off vessels was 81% vs. 25% in patients with one run-off vessel. Regarding the length of angioplasty, the hazard of reocclusion was 1.02 for every centimeter of occlusion (P = .049). CONCLUSIONS: The number of patent run-off crural vessels after the angioplasty and the length of occlusion are significant risk factors for reocclusion of infrainguinal SA in patients with CLI. Trying to recanalize more than one run-off vessels could raise the SA patency.