Effect of weight loss on regional body fat distribution in premenopausal women.

This study evaluates effects of weight loss on regional fat distribution and compares waist-to-hip ratio (WHR) and computed tomography (CT) as methods of assessing body fat distribution in 16 premenopausal obese women (body weight 104.3 +/- 18.1 kg, WHR 0.84 +/- 0.08). Mean weight loss was 6.6 kg after 2 wk on a very-low-energy diet (VLED) and 16 kg after 14 additional weeks on a low-energy diet (LED). Visceral abdominal fat and sagittal diameter significantly decreased after both the VLED and LED. Subcutaneous abdominal fat decreased significantly only after the LED. WHR showed no significant reduction over the entire study period. The decrease in visceral fat after both the VLED and LED was greater than the decrease in subcutaneous fat. Changes in body weight over the entire study period correlated with initial body weight and with total and subcutaneous abdominal fat, but not with visceral abdominal fat. They also correlated with changes in subcutaneous abdominal fat, visceral abdominal fat, sagittal diameter, and WHR. In conclusion, weight loss is associated with changes in regional fat distribution. In premenopausal subjects weight loss correlates more closely with the amount of subcutaneous than visceral fat.

Effects of age on body fat distribution and cardiovascular risk factors in women.

We conducted a cross-sectional study of body fat distribution and metabolic variables and the interrelations among these factors in 134 women aged 18-71.9 y. Body fat distribution was measured with use of computerized tomography. A significant positive correlation was observed between age and visceral adipose tissue (VAT) and between VAT and body weight. When subjects were divided into five age groups, VAT values were significantly higher in older groups. Values for triacylglycerols, cholesterol, fasting glucose, 2-h glucose, and the sum of glucose values during an oral-glucose-tolerance test were significantly higher in older subjects. After adjustment for visceral fat, no significant differences in any metabolic variable studied, except cholesterol, were found across the five age groups. In conclusion, we found that regional body fat distribution in older women was different from that in younger subjects: older women had larger amounts o visceral fat. Values for metabolic variables were also higher in older subjects. Our data suggest that redistribution of body fat in older subjects is associated with changes in metabolic variables.

Obesity and regional body-fat distribution in men: separate and joint relationships to glucose tolerance and plasma lipoproteins.

Relationships between obesity and fat distribution as evaluated by computed tomography and metabolic variables were studied in 35 men. Significant correlations emerged between body mass index and sum of glucose during oral glucose load and HDL3 triglycerides and also between visceral abdominal fat and triglycerides, apolipoprotein B, sum of insulin during oral glucose load, very-low-density-lipoprotein (VLDL) cholesterol, and VLDL and low-density-lipoprotein (LDL) triglycerides. Visceral abdominal fat correlated negatively with the ratio of HDL to LDL cholesterol. When the subjects were subdivided into four groups according to body mass index (< or = 26.7, > 26.7) and median visceral abdominal fat, no significant differences were found in body mass index, whereas significant differences were found for triglycerides, cholesterol, apolipoprotein B, VLDL cholesterol, HDL:LDL cholesterol, and VLDL triglycerides. Our study shows that the amount of visceral abdominal fat is the most relevant factor for metabolic abnormalities. Our data also suggest that the effect of visceral fat is independent of body mass index.

Relation of body fat distribution in men and degree of coronary narrowings in coronary artery disease.

This study evaluates the relation between body fat distribution and severity of coronary artery disease (CAD). The study sample comprised 33 patients with angiographically demonstrated CAD and 10 angiographically normal control subjects. Body fat distribution was estimated by computed tomography and degree of coronary narrowings by angiographic score. Body weight, body mass index and total and subcutaneous abdominal adipose tissue areas showed no statistical differences in the 2 groups; visceral abdominal adipose tissue area and the visceral to subcutaneous abdominal adipose tissue area ratio were significantly higher in patients with CAD (p < 0.05). There was a significant correlation between visceral fat and triglycerides, apoprotein B and sum of glucose and insulin during glucose oral tolerance test. Sum of insulin during glucose oral tolerance test, visceral abdominal adipose tissue area and visceral/subcutaneous abdominal adipose tissue area ratio correlated significantly with severity of CAD, as evaluated by coronary score in all subjects and in CAD patients alone. Stepwise multiple regression analysis using the coronary score as the dependent variable and anthropometric and metabolic parameters as independent variables shows that in all subjects and in CAD patients alone, visceral/subcutaneous abdominal adipose-tissue area ratio entered the regression first and the sum of insulin during glucose oral tolerance test second. The results suggest that visceral abdominal adipose tissue area and visceral to subcutaneous abdominal adipose tissue area ratio may be cardiovascular risk factors.

Interrelationships between intraabdominal fat and total serum testosterone levels in obese women.

Thirty-six women aged 18 to 52 years with body mass indexes (BMIs) between 27 and 52 were studied. Visceral and subcutaneous fat areas and body fat were evaluated by computerized tomography with a single scan at the IV-V lumbar vertebra level. Glucose, insulin, and C-peptide levels were measured before and after a glucose load. Total and free serum testosterone and 24-hour urinary cortisol excretion were measured. A stepwise multiple regression equation showed the visceral to subcutaneous fat area ratio to be the most powerful predictor for glucose alterations both during fasting and after a glucose load, and showed BMI to be the most powerful predictor for insulin and C-peptide levels. Total serum testosterone, after matching for age and BMI, demonstrates a significant negative correlation with visceral fat area. We conclude that in obese women, as in men, intraabdominal fat negatively correlates with serum testosterone levels.

Venous digital subtraction angiography in the evaluation of renovascular hypertension.

The study of renovascular hypertension (R.V.H.) presently requires multiple non invasive examinations in order to select between patients with R.V.H. or other kind of hypertension, before resorting to angiography. The use of venous digital subtraction angiography (V.D.S.A.) may change this diagnostic flow-chart. For this purpose, 100 patients with clinical and laboratory data suspect of R.V.H. underwent V.D.S.A. Compared to angiography, V.D.S.A. showed a 100% sensitivity and 93% specificity. Since the sensitivity and specificity of the non invasive techniques vs. V.D.S.A. in the same series was always lower, V.D.S.A. may be proposed as the first examination in the study of R.V.H. The arterial route for D.S.A. is generally not required for diagnostic purposes.

C. T. criteria of the differential diagnosis in primary retroperitoneal masses.

This personal series of 44 primary retroperitoneal masses (P.R.P.M.) studied by C. T. is analyzed. The reliability of C. T. in the identification (44/44), characterization (43/44) and origin evaluation (41/44) of P.R.P.M. has been absolutely satisfactory. In particular, those criteria of C. T. diagnosis which may be utilized in the evaluation of the origin of upper abdominal masses are thoroughly described. The evaluation of the involvement (non invasive; invasive) of adjacent viscera has been achieved in 22/38 P.R.P.M. verified at operation. The evaluation of tumour resectability has been less reliable due to the high incidence of under-diagnosis (60% in our personal experience). C. T. may be used in addition as an aid to different diagnostic techniques (percutaneous guided needle biopsy) or to therapy (drainage of retroperitoneal abscesses). C. T. is absolutely necessary in the follow-up of P.R.P.M. after surgery, radiotherapy or chemotherapy.

[Value of echography in the measurement of changes in the total and visceral adipose mass]. / Validità dell'ecografia nella valutazione delle modificazioni della massa adiposa totale e viscerale.

Various methods to assess lean and fat body masses and abdominal-visceral adipose tissue were compared in 26 obese women on extremely hypocaloric diets. The following anthropometric parameters were measured before and after 15 days of extreme calorie restriction: arm circumference (A), waist circumference (W), hip circumference (H) and thigh circumference (T); W/H, W/T, A/H and A/T ratios; subcutaneous biceps , triceps , subscapular, abdominal and thigh folds; echographic thickness of abdominal muscle-aorta; area of visceral (VAT), total (AT) and subcutaneous adipose tissue measured using computed tomography, lean and fat body masses assessed by impedance measurement. Under standard conditions it was shown that echography, like impedance measurement, was the most useful method for assessing lean and fat body masses in obese subjects, whereas plicometry was not found reliable. On extremely hypocaloric diets, echography is able to assess the variations of lean and fat body masses, whereas impedance measurement overestimated the lean body mass. Localisation indexes of visceral fat based on body circumferences were shown not to be suitable for the evaluation of changes in visceral adipose tissue, at least when these were slight. Echography was also the most useful method to assess slight changes in visceral adipose tissue.

[Morphologic imaging of thyroid carcinoma]. / L'imaging morfologico del carcinoma tiroideo.

Ultrasonography (US) is the choice morphological imaging modality in the study of thyroid carcinomas. The present technological evolution (high frequency probes, development of Colour-Doppler) allows the detection of small non-palpable nodules, being able to define, in a high percentage of cases, features pointing to the malignant character of a thyroid mass, although the definite assessment of malignancy (invasion of adjacent structures, metastatic cervical nodes) is quite rare. From a diagnostic viewpoint US is required to identify nodules with suspect features, to be submitted to fine needle aspiration biopsy. Moreover, US plays a basic role in the staging--at the cervical level--of carcinomas as well as in the post-operative follow-up. The other imaging modalities (Computed Tomography, Magnetic Resonance Imaging) play a limited role in both staging and post-operative follow-up.

[Imaging in pediatric urology: answers to clinical questions "adjusted" to the age of the patient]. / Il contributo dell'imaging in urologia pediatrica: risposte a quesiti clinici "modulati" dall'età del paziente.

The contribution of the Imaging modalities to the diagnostic work-up of urologic pathology in the pediatric age has been greatly affected, in the last twenty years, by the development of new diagnostic means, notably sonography. This has lead to a true revolution in the study of the small patient, aimed at reducing as much as possible the radiation exposure. The further evolution of nuclear medicine exams has allowed a great gain in the functional evaluation of the urinary system; the more recent development of color doppler sonography as well as of the more sophisticated power doppler is opening new horizons in this area. On the contrary, the resort to multiplanar Imaging modalities (CT, MRI) plays a limited role in pediatric urology, being confined to very special and complex cases.

[Neonatal ultrasonic screening and follow up of urinary tract malformations]. / Screening ecografico neonatale e follow-up delle uropatie malformative.

1881 consecutive healthy newborn babies underwent abdominal ultrasonography on day 4-6. 228 subjects presented an echographic abnormality. Renal abnormalities were diagnosed in 213 newborn. Of those, 134 had dilatative uropathy with a pelvic diameter greater than 5 mm, 73 renal medulla hyperechogenicity, 3 ectopics, 2 unilateral renal agenesis and one horseshoe kidney. Extrarenal findings were present in 15 neonates: 11 with surrenal gland haemorrhage and 4 with hepatic ultrasonographic alterations. Grignon classification was used for evaluation of the dilatative urinary tract abnormalities. In 173 renal pelvis (134 neonates) the anteroposterior diameter was found > 5 mm: 97 were classified as GI (5-10 mm), 45 as GII (10-15 mm), 13 as GIII ( > 15 mm), 11 as GIV (moderate dilatation of the calyces with easily identified residual renal cortex) and 7 as GV (severe dilatation of the calyces with atrophic cortex). The follow-up of 72.3% of these abnormalities showed a spontaneous normalization in 90% of GI, 73% of GII and 58% of GIII. Only one patient with GIII demonstrated progressive dilatation and he underwent corrective surgery. 15 of the 17 newborn with severe uropathy (GIV-GV), had regular follow-up. 8 underwent surgery and 7 showed a progressive spontaneous recovery and in 4 of these cases a complete resolution. The ultrasound follow-up of all cases of renal medulla hyperechogenicity and surrenal gland haemorrhage shows a spontaneous resolution without any clinical or biochemical complication.

The Legnano radiology picture archiving and communication system/radiology information system project implementation.

The necessity to meet the ever-increasing diagnostic and interventional demands in the most cost-effective and efficient way led to the decision to turn the Department of Radiology at Legnano City Hospital nearly filmless. Crucial for the implementation of this challenging project was the development of a sophisticated and efficient digital architecture along with a nearly global renovation of the whole department, connecting it in the meantime to the hospital asynchronous transfer mode (ATM) backbone. The highlights and drawbacks faced in the implementation of the project are described and discussed.

Effects of visceral fat and weight loss on lipoprotein(a) concentration in subjects with obesity.

We studied the relationships between regional body fat distribution and metabolic variables with lipoprotein(a) [Lp(a)] as well as the effects of weight loss on Lp(a) in 25 women and 9 men with obesity. Regional body fat distribution, as evaluated by the use of computed tomography; Lp(a); and fasting glucose, insulin, cholesterol, and triglycerides were analyzed before and after a very low-energy diet. No significant correlations were found between visceral, subcutaneous, and total fat and Lp(a) or between metabolic variables and Lp(a). All anthropometric variables significantly decreased after a very low-energy diet. Fasting glucose, insulin, triglycerides, and cholesterol significantly decreased after a very low-energy diet. No significant changes in Lp(a) concentration after a very low-energy diet were found. The correlation between the initial values of Lp(a) and changes of Lp(a) after a very low-energy diet was slightly significant (rho = 0.33, p < 0.06). In conclusion, our study shows that Lp(a) is not influenced by obesity, visceral fat, metabolic variables, or weight loss induced by a very low-energy diet.

[Radiologic approach to endocrine pathology in childhood]. / Approccio radiologico alla patologia endocrina in età pediatrica.

The new imaging techniques (ultrasound, CT, digital subtraction angiography) have greatly modified the diagnostic approach to the endocrinopathies in pediatric age, notably if of surgical interest. The main clinical indications to the ultrasound and/or CT study of hypophysis, thyroid, adrenals and female internal genital tract are synthesized in this paper. A diagnostic flow-chart is also suggested for each clinical entity.

The contribution of sonography to the measurement of intra-abdominal fat.

A study was conducted on a group of 50 obese females with a mean body mass index of 39 +/- 16, aged 19 years, in order to determine if sonography could be adopted as a direct means for measuring intra-abdominal fat deposits. Adipose tissue evaluation was performed by computed tomography (CT) and ultrasonography (using 3.5-MHz and 5-MHz probes) at the L4 level. CT intra-abdominal fat area (VAT) and ultrasonography visceral thickness from abdominal muscle to aorta were the values mainly considered. Ultrasonographic intra-abdominal thickness correlated well with VAT (r = 0.669, p less than 0.001), supporting the hypothesis that ultrasonography could be useful in the direct evaluation of intra-abdominal fat deposits.

Total and intra-abdominal fat measurements by ultrasound and computerized tomography.

Computerized tomography, a method of proven reliability for direct measurement of both total and visceral body fat, is not widely usable and alternative means of assessing body fat are required. Several anthropometric parameters, including ultrasound measurements of intra-abdominal and subcutaneous fat, were considered in 119 females (age 15-72 years, body mass index 24-51 kg/m2). Computerized tomography was also performed for total and visceral fat areas at the L4-L5 level. Reliability of each of these measurements in predicting total fat was assessed. Tertiles for visceral fat area were calculated (< 114, 114-170, > 170 cm2). Only ultrasound intra-abdominal fat measurements were able to distinguish between all three VAT groups (16 +/- 10, 32 +/- 13, 50 +/- 22 mm); neither sagittal diameter nor waist/hip girth ratio were able to distinguish between the two > 114 cm2 groups. Predictive equations for total adipose tissue area confirmed weight/height ratio as the best predictor of total fat. Ultrasound intra-abdominal thickness was the 1 degree variable to enter the stepwise regression in predictive equations for visceral adipose tissue area. The 2 degrees was age, the 3 degrees sagittal diameter, the 4 degrees waist/hip girth ratio and the 5 degrees ultrasound subcutaneous abdominal thickness (adjusted r2 = 0.784; P < 0.001).

Cystic islet cell tumors of the pancreas. A clinico-pathological report of two nonfunctioning cases and review of the literature.

Cystic islet cell tumors of the pancreas are extremely rare. The authors report their personal experience with two cases of nonfunctioning cystic endocrine neoplasms. The tumor was diagnosed preoperatively in one case by ultrasonography (US)-guided fine-needle aspiration cytology, while in the other it was identified only in the surgical specimen after a clinical-radiologic diagnosis of pancreatic mucinous cystic tumor. Immunohistochemical assay showed positivity for the generic neuroendocrine markers (neuron specific enolase, or NSE, synaptophysin, and chromogranin A) in both cases and also for glucagon in one case. The neoplasms were resected by distal pancreatectomy with splenectomy and intermediate pancreatectomy respectively. Both patients are alive and recurrence-free 6 mo and 2.5 yr, respectively, after surgery. The authors also review the existing literature, discussing the pathogenesis of such tumors and the imaging techniques and surgical strategies adopted in their management.

Sonography detection of small intra-abdominal fat variations.

The aim of this study was to check the reliability of sonography in measuring small variations in quantities of subcutaneous and intra-abdominal fat. Twenty-six obese women (BMI 39 +/- 6) underwent a 15 day very low calorie diet. The study included, both before and after very low calorie diet, computed tomography measurements of total (AT), visceral (VAT) and subcutaneous (SAT) adipose tissue areas, visceral/subcutaneous area ratio (V/S), waist/hip circumference ratio measurements (W/H), and ultrasound measurements of abdominal subcutaneous skin-muscle thickness, intra-abdominal muscle-aorta thickness and intra-abdominal/subcutaneous thickness ratio. Weight reduction was from 101 +/- 17 to 95 +/- 16 kg (P less than 0.001). W/H dropped from 0.83 +/- 0.06 to 0.82 +/- 0.07 (n.s.). VAT dropped from 158 +/- 72 to 134 +/- 61 cm2 (P less than 0.005), SAT from 572 +/- 151 to 566 +/- 164 cm2 (n.s.) and V/S from 0.29 +/- 0.15 to 0.25 +/- 0.11 (P less than 0.01). Abdominal subcutaneous fat thickness decreased from 36 +/- 8 to 35 +/- 10 mm (n.s.), intra-abdominal thickness from 39 +/- 25 to 20 +/- 20 mm (P less than 0.001) and intra-abdominal/subcutaneous from 1.1 +/- 0.7 to 0.8 +/- 0.6 (P less than 0.005). VAT measurement accurately identified small intra-abdominal fat variations. W/H could not evaluate visceral fat loss, because of simultaneous decreases in waist and hip circumferences. Ultrasound was able to measure small reductions in intra-abdominal fat.

Effect of regain of body weight on regional body fat distribution: comparison between pre- and postmenopausal obese women.

The aim of our study was to determine if regain of body weight increases visceral fat in obese women and if regain of weight has a different effect upon pre- and postmenopausal women. Twenty obese women (11 pre- and 9 postmenopausal) underwent a very low energy diet (VLED) for 2 weeks to lose weight. They then regained body weight in spite of the recommended hypocalorie diet. No significant modifications in body fat distribution indexes were found by computed tomography between VLED and after regain of weight. No significant changes were found in metabolic variables. No interactions between menopausal status and regain of body weight were observed. In conclusion, regain of weight does not seem to cause an increase in visceral fat; both pre- and postmenopausal women showed the same body fat distribution before weight loss and after regain of weight.