Overweight and obesity status from the prenatal period to adolescence and its association with non-alcoholic fatty liver disease in young adults: cohort study.

OBJECTIVE: To examine the associations of maternal and child overweight status across multiple time-points with liver fat content in the offspring during young adulthood. DESIGN: Cohort study. SETTING: ELEMENT Cohort in Mexico City. POPULATION: Pregnant women with singleton births (n = 97). METHODS: We quantified hepatic triglyceride content (liver fat content) by proton magnetic resonance spectroscopy (1H MRS) and conventional T2-weighted MRIs (3T scanner) in 97 young adults from the ELEMENT birth cohort in Mexico City. Historical records of the cohort were used as a source of pregnancy, and childhood and adolescence anthropometric information, overweight and obesity (OWOB) were defined. Adjusted structural equation models were run to identify the association between OWOB in different life stages with liver fat content (log-transformed) in young adulthood. MAIN OUTCOME: Maternal OWOB at the time of delivery was directly and indirectly associated with the liver fat content in the offspring at young adulthood. RESULTS: Seventeen percent of the participants were classified as having NAFLD. We found a strong association of OWOB between all periods assessed. Maternal OWOB at time of delivery (ß = 1.97, 95% CI 1.28-3.05), and OWOB status in the offspring at young adulthood (ß = 3.17, 95% CI 2.10-4.77) were directly associated with the liver fat content in the offspring. Also, maternal OWOB was indirectly associated with liver fat content through offspring OWOB status. CONCLUSION: We found that maternal OWOB status is related to fatty liver content in the offspring as young adults, even after taking into account OWOB status and lifestyle factors in the offspring. TWEETABLE ABSTRACT: There was an association between pre-pregnancy overweight and the development of NAFLD in adult offspring.

Diagnostic performance of PWI/DWI MRI parameters in discriminating hyperacute versus acute ischaemic stroke: finding the best thresholds.

AIM: To determine the accuracy of the perfusion/diffusion-weighted imaging (PWI/DWI) parameters [time to peak (TTP), mean time to peak (MTT), relative cerebral blood volume (rCBV), and relative cerebral blood flow (rCBF) maps]; in the evaluation of acute versus hyperacute ischaemic stroke. MATERIALS AND METHODS: Fifty-five patients with symptomatic hyperacute (first 6h) or acute (7-24h) ischaemic stroke underwent diffusion and perfusion evaluation. Statistical analysis included Student's t-test, receiver operating characteristics (ROC) analysis of apparent diffusion coefficient (ADC), TTP, MTT, CBV, and CBF; correlation, linear, and logistic regression analysis. RESULTS: Area under receiver operating characteristics (AUROC) analysis identified the ADC cut-off value 385×10(-6)mm(2)/s, MTT at 109.5%, TTP at 3.05s, CBV at 129%, and CBF at 98.5% (the record of the time of onset was considered the reference standard). The best performance corresponded to TTP, which showed a sensitivity of 0.94 and specificity of 0.88 (p<0.001). CONCLUSIONS: Based on the present findings, hyperacute penumbra is reliably defined with a TTP >3s with no visible changes in diffusion. ADC, rCBF, and rCBV are not useful for discriminating between acute and hyperacute ischaemic stroke.

Whole-body (18)F-FDG PET/CT in primary non-Hodgkin's lymphoma of the thyroid associated with Hashimoto's thyroiditis and bilateral kidney infiltration.

An 82-year-old female patient with hypothyroidism and Hashimoto's thyroiditis noted three years ago to have a small asymmetric goiter (left > right). Nevertheless, a rapid growth of the thyroid over 3-6 months caused dysphagia and shortness of breath. Ultrasound and a thyroid gammagram showed an image consistent with multinodular goiter with a hyperfunctioning nodule in the right lobe. Due to the history of Hashimoto's thyroiditis and a rapid increase in size of the thyroid gland, diagnoses of thyroid lymphoma and anaplastic thyroid cancer were considered. Thyroidectomy was attempted at an outside facility to relieve compressive symptoms. Fine needle aspiration was insufficient for diagnosis, and the product of thyroidectomy confirmed the diagnosis of diffuse large B-cell lymphoma. A positron emission tomography/computed tomography scan was performed in our institution for staging, revealing nodal and extranodal metastasis. Chemotherapy using cyclophosphamide, vincristine and dexamethasone (COP modified) led to a dramatic response of the tumor and a complete resolution of compressive symptoms.

(18)F-FDG PET/CT for discrimination between tumor extension and blood thrombus in pancreatic adenocarcinoma associated with portal vein thrombosis.

Pancreatic cancer is a malignancy with an extremely poor prognosis. Less than 3 % of patients are alive 5 years after diagnosis. Pancreatic neoplasms represent a possible but uncommon etiology of portal venous invasion. It is important to differentiate the nature of the thrombus, if it is a bland thrombus or is a direct tumor extension. Intense uptake of 18F-fluorodeoxyglucose ((18)F-FDG) has been reported in portal vein tumor thrombus. We present a case of pancreatic adenocarcinoma and clinical findings of portal hypertension due to portal vein thrombosis. (18)F-FDG positron emission tomography (PET)/computed tomography (CT) evaluation discarded a tumor thrombus; imaging findings of the pancreatic tumor and the bland thrombus are presented.

Tomographic findings in traumatic globe evulsion caused by blunt head trauma.

Evulsion of the globe as a result of trauma is a rarity; to the best of our knowledge, only four "evulsions of the globe" have been described. We present the case of a 35-year-old Hispanic woman with traumatic evulsion of the right eye and subarachnoid haemorrhage. The management of brain injury was the priority over preservation of globe structures. We briefly describe the tomographic features of this uncommon situation and the proposed "evulsion" mechanism.

Non-resected solid papillary epithelial tumor of the pancreas: 18F-FDG PET/CT evaluation at 5 years after diagnosis.

Solid and papillary epithelial neoplasm of the pancreas (SPEN) is an encapsulated, slowly enlarging abdominal mass that generally shows no evidence of capsular invasion, regional lymph node involvement, or distal metastases. We present a 68 years old Hispanic male diagnosed with SPEN 5 years earlier that refused surgical excision. Presently he underwent a whole-body 18F-FDG PET/CT. Although tumor size, location and CT features did not seem to depict significant changes, FDG-PET was useful showing persistent tumoral activity. A brief review of the differential diagnosis as well as the usefulness of FDG-PET in SPEN (a slow growing pancreatic neoplasm) is presented.

Early MRI findings of central pontine myelinolysis following "rapid" correction of hyponatraemia during diabetic ketoacidosis. A curious pontine lesion (2003:12b).

We describe a diabetic patient with hyponatraemia and ketoacidosis who developed central pontine myelinolysis (CPM) after a very rapid correction of serum sodium. In diabetic ketoacidosis, the marked shifts in osmolarity make these patients more susceptible to the development of CPM. The dramatic early MRI findings (after three weeks) should raise awareness of the risk of permanent damage to the brain associated with hydration therapy in this susceptible group. Magnetic resonance imaging might be a useful investigation at presentation and follow-up of diabetic patients with extreme metabolic derangements.

Asymptomatic true gallbladder duplication: a case report and review of the literature.

Gallbladder duplication is a rare event, with an incidence at autopsy of about 1/4000, with very few documented symptomatic cases reported. Preoperative diagnosis and differentiation of this malformation are important to prevent inadvertent damage to the biliary system, a complicated postoperative course, and repeat surgery. We present a case of true gallbladder duplication found incidentally during abdominal ultrasonography (US). The diagnosis was made with US and the Y-type duplication was demonstrated with magnetic resonance cholangiopancreatography (MRCP).

[Pulmonary thromboembolism associated with glioblastoma multiforme: imaging diagnosis of a case and a review of the literature]. / Tromboembolia pulmonar asociada a glioblastoma multiforme: diagnóstico por imagen de un caso y revisión de la bibliografía.

INTRODUCTION: The incidence of deep vein thrombosis and pulmonary embolism in patients with cerebral neoplasia has been estimated at 120/100,000 (the second highest rate for any kind of malignant neoplasia). A timely diagnosis is an indispensable requisite in the clinical evaluation of neurological patients. Patients suffering from glioblastoma multiforme present a generalized state of hypercoagulability with a deep vein thrombosis incidence after surgery of between 3 and 60%. The incidence with which pulmonary embolism occurs is 5% in patients following neurosurgical operations, with a mortality rate of between 9 and 50%. CASE REPORT: We report the case of a 64 year old male patient with a suspected diagnosis of pulmonary thromboembolism and thrombosis of the right lower limb. Clinical studies included a simple chest X ray, a Doppler ultrasound recording of the lower limbs, a spiral computed tomography (CAT) scan of the thorax, and a magnetic resonance (MR) scan of the head. The spiral CAT scan showed filling defects in the main pulmonary arteries, a tram track appearance and central filling defects. All these findings are compatible with an imaging diagnosis of pulmonary thromboembolism. CONCLUSIONS: The main aim of this study was to describe the use of spiral CAT scanning as a primary tool in the diagnosis of a case. The concurrence of the spiral scan image, the abnormal increase in D dimer and the clinical information left no doubts about the diagnosis. The clinical manifestations of pulmonary thromboembolism are not specific and therefore the patient s life is at risk. In addition, few reports have been published about the association between glioblastoma multiforme and the later appearance of pulmonary thromboembolism (a search was conducted in the medical literature from the last 10 years using MEDLINE), and hence we have presented a communication dealing with this pathological association together with a brief review of the clinical diagnosis of pulmonary thromboembolism and its physiopathogenic mechanisms.

[Colloid cyst of the third ventricle: case description and survey of the literature]. / Quiste coloide del tercer ventrículo: descripción de un caso y revisión de la bibliografía.

INTRODUCTION: Colloid cysts are intracranial lesions with an estimated incidence of three individuals per million people per year. They are benign tumours in the anterosuperior portion of the third ventricle. The normal flow of cerebrospinal fluid may be interrupted by a large cyst that obstructs the foramen of Monro. The associated signs and symptoms cover a wide range of features, from non specific headaches to intracranial hypertension data; some colloid cysts occur at the acute onset of hydrocephalus and can lead to a sudden death. CASE REPORT: We present the case of a patient with a colloid cyst in the anterior roof of the third ventricle, with the presence of a dysfunctional ventriculo peritoneal bypass valve, which had been introduced three years earlier. Both events contributed to the development of a hydrocephalus with clinical manifestations of intracranial hypertension. The images obtained by magnetic resonance (MR) revealed the presence of a hyperintense mass of variable density in the roof of the third ventricle and in its rostral face; the image was hyperintense in T1 and isointense in T2. The patient was submitted to an endoscopic cisternoventriculostomy to allow the surgical drainage of the colloid cyst, and management was continued in the outpatients department of the Neurosurgery Service. CONCLUSIONS: In this paper we discuss the main characteristics of the colloid cyst, some considerations on its presentation in MRI are presented and a brief survey of the literature is also conducted.

Zinc salts precipitate unconjugated bilirubin in vitro and inhibit enterohepatic cycling of bilirubin in hamsters.

BACKGROUND: We have evidence for enterohepatic cycling of bilirubin experimentally and in vivo in humans. This study was designed to investigate whether Zn salts might inhibit such cycling of bilirubin. MATERIALS AND METHODS: Micellar bile salt solutions with unconjugated bilirubin were prepared, appropriate concentrations of Zn salts were added, and unconjugated bilirubin precipitation was measured. Hamsters and Wistar rats were fed a chow diet or a chow diet enriched with 1% ZnSO4, and bilirubin secretion rates were monitored. RESULTS: Unconjugated bilirubin was precipitated maximally (90%) after a 10-min incubation with 5 mM Zn salts in the pH range of 6.8-9.0. In control hamsters, total bilirubin secretion rates into bile were 36.0 +/- 2.8 nmol h(-1) 100g(-1) body weight, whereas they were 25.0 +/- 3.3 nmol h-1 100(-1) g in the ZnSO4 group (P < 0.05). CONCLUSIONS: Zn salts that flocculate at physiological pH adsorb unconjugated bilirubin almost completely from unsaturated micellar BS solutions. In addition, Zn salts administered orally suppress biliary bilirubin secretion rates in hamsters. These findings suggest that the administration of Zn salts may inhibit the enterohepatic cycling of unconjugated bilirubin in humans who are predisposed to pigment gallstone formation due to diet, disease or drugs.

Cholesterolosis is not associated with high cholesterol levels in patients with and without gallstone disease.

High levels of cholesterol have been associated with certain gallbladder disorders such as cholesterolosis and gallstone disease. Furthermore, obesity is considered the main risk factor for cholesterol gallstone disease. We investigated the incidence of cholesterolosis in patients with and patients without gallbladder stones (GS). We reviewed the clinical records of patients with gallstone disease and other gallbladder disorders who had consecutive cholecystectomy during a 5-year period. We recorded demographic data, sex, age, serum cholesterol levels, and body mass index. The diagnosis of cholesterolosis was made macroscopically and microscopically. A total of 636 patients were included in this study: 446 with and 190 without GS. Cholesterolosis was more frequent in patients without GS (p < 0.01). However, hypercholesterolemia occurred more frequently in patients with GS (p < 0.001). Obese patients with GS had higher percentages of cholesterolosis and hypercholesterolemia than did eutrophic patients (p < 0.01 and p < 0.05, respectively). We suggest that cholesterolosis in the human gallbladder is not necessarily associated with gallstone disease and high plasma cholesterol levels.