Waist-to-height ratio is independently related to whole and central body fat, regardless of the waist circumference measurement protocol, in non-alcoholic fatty liver disease patients.

BACKGROUND: Waist-to-height ratio (WHtR) has been reported as a preferable risk related body fat (BF) marker, although no standardised waist circumference measurement protocol (WCmp) has been proposed. The present study aimed to investigate whether the use of a different WCmp affects the strength of relationship between WHtR and both whole and central BF in non-alcoholic fatty liver disease (NAFLD) patients. METHODS: BF was assessed with dual energy X-ray absorptiometry (DXA) in 28 NAFLD patients [19 males, mean (SD) 51 (13) years and nine females, 47 (13) years]. All subjects also underwent anthropometric evaluation including height and waist circumference (WC) measurement using four different WCmp (WC1, minimal waist; WC2, iliac crest; WC3, mid-distance between iliac crest and lowest rib; WC4, at the umbilicus) and WHtR was calculated using each WC measurements (WHtR1, WHtR2, WHtR3 and WHtR4, respectively). Partial correlations were conducted to assess the relation of WHtR and DXA assessed BF. RESULTS: All WHtR were particularly correlated with central BF, including abdominal BF (r = 0.80, r = 0.84, r = 0.84 and r = 0.78, respectively, for WHtR1, WHtR2, WHtR3 and WHtR4) and central abdominal BF (r = 0.72, r = 0.77, r = 0.76 and r = 0.71, respectively, for WHtR1, WHtR2, WHtR3 and WHtR4), after controlling for age, sex and body mass index. There were no differences between the correlation coefficients obtained between all studied WHtR and each whole and central BF variable. CONCLUSIONS: Waist-to-height ratio was found a suitable BF marker in the present sample of NAFLD patients and the strength of the relationship between WHtR and both whole and central BF was not altered by using different WCmp in the present sample of NAFLD patients.

[Large and extensive thoracoabdominal aortic aneurysm in a seropositive young woman, treated with the "simplified technique"]. / Volumoso e extensor aneurisma da aorta toracoabdominal em mulher jovem seropositive, tratado pela "técnica simplificada". Caso clínico.

The clinical case of a 37 years old female with the previous diagnosis of human immunodeficiency virus infection (HIV), under medical control, is reported, in whom an extensive and large thoracoabdominal aortic aneurysm was diagnosed (type II of the Stanley Crawford's classification), completely asymptomatic. The patient underwent surgical management, consisting in the resection of the aneurysm and prosthetic replacement, utilizing the "simplified technique", that was once again extremely well succeeded in this most demanding situation. The clinical and pathological features of this infection and the potential involvement in the pathogenesis of this uncommon aneurysm are discussed, according to the data published in the literature. Furthermore, the main aspects of the surgical management are described and discussed, facing the diverse technical alternatives nowadays used in clinical practice.

[Preoperative evaluation of superficial veins to be used in peripheral arterial revascularization surgery]. / Avaliação pré-operatória das veias superficias a utilizar na cirurgia de revascularização periférica.

In this paper, the authors report their experience in the preoperative evaluation of the superficial veins of the lower limbs, using the color-coded Eco-Doppler, aimed at the evaluation of morphofunctional aspects of the veins, allowing an objective and reliable selection of the vein grafts to be used in peripheral arterial revascularization surgery. The advantages and disadvantages of the methodology are analysed and discussed, and they concluded by stating that the method can replace favourably the tradicional surgical exploration, avoiding the frequent unnecessary , unusefull or inconvenient surgical exploration for the veins assessment.

[Revascularization to the midpopliteal artery through a posterior approach. Two case reports]. / Revascularização da artéria popliteal media por abordagem posterior. A proposito de dois casos clinicos.

An original technique consisting in the revascularization of the midpopliteal artery through a posterior approach is described, in patients with critical ischemia of the lower extremities, utilizing a prosthetic substitute. This technique can be regarded as an alternative to the infragenicular revascularization and it is particularly suited for patients with no autologous material available. Two successful cases operated on with this technique are reported, with a 6 months and 1 year follow up and documented patency of the grafts.

[Traumatic vasculo-orthopedic combined lesions: 18-years retrospective evaluation of epidemiology and risks factors for amputation]. / Lesoes traumáticas vasculo-ortopédicas combinadas: estudo retrospectivo des 18 anos centrado na epidemiologia e factores de risco para a amputação.

This study was undertaken to assess retrospectively the epidemiology and risk factors for amputation of combined vasculo-orthopaedic traumatic lesions, during a 18-year period, from March 1987 to May 2005, comprising the review of the clinical charts of 149 patients. The series includes a predominance of male patients (84%) with an average age of 34 years. Eighty-five per cent of the lesions resulted from traffic accidents (49% velocipedes, 39% automobiles, 12% trampling), 10% were consequence of falls and 5% resulted from agriculture activities. Orthopaedic lesions include 83 fractures of upper limbs (22 open), 123 of lower limbs (67 open), 21 scapulo-thoracic dissociations and 27 knee dislocations. Vascular lesions include 8 subclavian, 20 axillary, 25 braquial, 10 radial, 6 ulnar and 2 diverse, in the upper limbs; and in lower limbs 4 iliac, 27 femoral, 52 popliteal, 5 tibio-peroneal trunk, 5 anterior tibial, 12 posterior tibial and 12 peroneal. Overall mortality was 3.3% and the amputation rate was 17%. Knee dislocations were responsible for one third of amputations, followed by fractures of bone legs. The association of femur to bone legs fractures from one side and of the knee to bone legs fractures from the other, coursed with high levels of amputation, together with lacerations and crushing of the limbs. The prompt diagnosis of the lesions and the immediate, hierarchic and multidisciplinary approach were considered also as relevant prognostic factors in the management of these most demanding conditions.

Body composition and body fat distribution are related to cardiac autonomic control in non-alcoholic fatty liver disease patients.

BACKGROUND/OBJECTIVES: Heart rate recovery (HRR), a cardiac autonomic control marker, was shown to be related to body composition (BC), yet this was not tested in non-alcoholic fatty liver disease (NAFLD) patients. The aim of this study was to determine if, and to what extent, markers of BC and body fat (BF) distribution are related to cardiac autonomic control in NAFLD patients. SUBJECTS/METHODS: BC was assessed with dual-energy X-ray absorptiometry in 28 NAFLD patients (19 men, 51±13 years, and 9 women, 47±13 years). BF depots ratios were calculated to assess BF distribution. Subjects' HRR was recorded 1 (HRR1) and 2 min (HRR2) immediately after a maximum graded exercise test. RESULTS: BC and BF distribution were related to HRR; particularly weight, trunk BF and trunk BF-to-appendicular BF ratio showed a negative relation with HRR1 (r=-0.613, r=-0.597 and r=-0.547, respectively, P<0.01) and HRR2 (r=-0.484, r=-0.446, P<0.05, and r=-0.590, P<0.01, respectively). Age seems to be related to both HRR1 and HRR2 except when controlled for BF distribution. The preferred model in multiple regression should include trunk BF-to-appendicular BF ratio and BF to predict HRR1 (r2=0.549; P<0.05), and trunk BF-to-appendicular BF ratio alone to predict HRR2 (r2=0.430; P<0.001). CONCLUSIONS: BC and BF distribution were related to HRR in NAFLD patients. Trunk BF-to-appendicular BF ratio was the best independent predictor of HRR and therefore may be best related to cardiovascular increased risk, and possibly act as a mediator in age-related cardiac autonomic control variation.