Renal cancer staging: Comparison of contrast-enhanced CT and gadolinium-enhanced fat-suppressed spin-echo and gradient-echo MR imaging

Fifty-three consecutive patients with 61 solid or complex non-fat-containing renal masses compatible with renal cancer were examined with contrast-enhanced computed tomography (CT) and magnetic resonance (MR) imaging with pre- and postcontrast FLASH (fast low-angle shot) and fat-suppressed spin-echo sequences. CT and MR imaging were performed within a 1-month interval. CT and MR images were prospectively interpreted. Tumor detection and staging were determined in all patients. CT and MR imaging enabled detection of 54 and 58 of 61 renal tumors, respectively. CT and MR imaging showed 34 and 35 of 38 histologically proved renal tumors, respectively, in 31 patients. Tumor size on CT and MR images demonstrated good correlation and correlated well with the size of pathologic specimens of 34 of 38 resected tumors detected with CT and MR imaging (r =.99). Of the 31 tumors in 31 patients who underwent surgical resection, 24 were correctly staged with CT and 29 with MR imaging. CT and MR imaging both enabled correct staging of four of five additional tumors with biopsy proof of tumor stage. A moderate difference in staging was observed between CT and MR imaging (P =.05). CT showed 13 and MR imaging 15 of 15 tumor thrombi. CT and MR imaging both showed 11 of 11 cases of adenopathy. The results suggest that MR imaging is moderately better than CT for the detection and staging of renal cancer.     

Studies on the antilipolytic effect of adenosine and related compounds in isolated fat cells

Summary Basal lipolysis in isolated fat cells of rats was increased by adenosine in a dose-dependent manner. Low concentrations of this nucleoside (1–10 M) inhibited noradrenaline-induced glycerol production by about 50% and completely blocked the effect of theophylline on fat cells. Glycerol release, induced by dibutyryl cyclic AMP, was increased by 5 M adenosine. Inosine, hypoxanthine, and xanthine had weaker antilipolytic properties, whereas adenine was virtually without effect.Although dipyridamole (20 M) strongly decreased the uptake of adenosine into fat cells, it did not counteract the antilipolytic action of this nucleoside. Low concentrations of adenosine (0.1 M), which by themselves were without any effect, greatly enhanced the effect of insulin on lipolysis. It is tentatively suggested that adenosine may be involved in the physiological control of lipolysis and that this nucleoside has its site of action on the cell membrane.Recipient of a Deutsche Forschungsgemeinschaft scholarship     

Regional differences in the lipolytic response of the subcutaneous fat depots to prolonged exercise and severe energy deficiency

Summary After five days of almost continuous strenuous combat exercise and energy deficiency, 12 well-trained young men had a mean body fat loss of 2.7 kg and the average fat cell size was reduced from 0.34 g to 0.24 g. No significant changes were found in the total number of fat cells. For the group as a whole, the decrease in fat cell size was most pronounced in the gluteal subcutaneous region, followed by the abdominal region. No significant decrease in fat cell size was encountered in tissue samples from the femoral site. Before the course, and on the last day, the subjects accomplished a short-term bicycle exercise at 50% of the individual's . On day 5, positive correlations were found between the fat cell weights estimated in the gluteal tissue samples and the pre-exercise free fatty acid (FFA) levels (r=0.87, p<0.01), and also with the plasma free glycerol obtained five minutes after the bicycle exercise (r=0.93, p<0.001). These correlations were not apparent in the control experiment performed before the course. Further, no such relationship was found between the plasma metabolites and the fat cell size of the other body sites investigated. This finding may indicate that gluteal fat deposits are more important for energy provision than abdominal and, especially, femoral deposits.     

Coronal oblique turbo STIR imaging of the sacrum and sacroiliac joints at routine MR imaging of the lumbar spine

The objective of the study was to evaluate the clinical impact of coronal oblique imaging of the lumbrosacral junction and the sacrum at initial presentation for MR imaging of the lumbar spine in patients presenting with low back pain or sciatic pain. Two hundred and sixty consecutive patients attending for MRI of the lumbar spine underwent simultaneous coronal oblique turbo short tau inversion recovery (STIR; TR 2500, TE 40, TI 150, echo train length 7, number of scan acquisitions 2) imaging of the sacrum and the sacroiliac joints with a field of view of 30-cm and 3-mm slices (acquisition time 3 min and 20 s). Images were reviewed by two experienced radiologists to determine the cause of back pain, with and without images of the sacrum and sacroiliac joints. The added value of the additional sequence was assessed. Correlation was made with surgery, response to nerve root injection or clinical follow-up at 3 months. Subgroup analysis was performed to determine if patient stratification according to sex or symptoms would be useful. In total, in 19 of 260 patients (7.3%), abnormalities were identified at coronal STIR imaging. In 7 of 260 patients (2.7%), pathology was identified in the sacrum thought to account for back pain, altering the diagnosis made on the standard sequences. These diagnoses were sacroiliitis (n=2), sacral stress fracture (n=1), degenerative sacroiliac joints (n=1), degenerative accessory articulation between the lumbar spine and the sacrum (n=1), Tarlov cyst of nerve root (n=1) and retroverted uterus causing sciatic pain (n=1). Patient stratification according to sex or the presence or absence of sciatic symptoms was not useful in predicting the added benefit of the additional sequence. Routine coronal STIR imaging of the sacrum as part of lumbar spine MRI improves assessment of patients presenting with low back pain or sciatica in only a small number of patients.     

Giant fatty Schmorl’s nodes: CT findings in four patients

Objective To describe the CT features of an unusual type of lumbar Schmorls node (SN) appearing as giant fatty lesion of the vertebral bodies.Design and patients >Four patients (4 men; mean age 48.5 years) collected during a 9-month period were examined with MDCT for unremarkable lumbar symptoms; none had relevant history of specific trauma during the last years preceding the CT.Results and conclusions The CT findings had a similar showing: a central or para-central osteolytic lesion in contact with the upper end plate of the vertebra, occupying about two-thirds to three-quarters of the body height and being surrounded by a thin and well-delineated bony rim. There was a clear interruption of the superior vertebral end plate above the lesion and an almost normal height of the adjacent vertebral disk. The CT appearance suggested a uniform fat content which was confirmed by density measurements ranging from –20 to –30 HU. The origin remains unknown, but a parallel is drawn between giant fatty SNs and giant cystic SNs. Intravertebral disk herniation is likely to be the initial phenomenon, with a preponderant responsibility of the secondary induced intramedullar tissular disorders to constitute the final size of the lesion. One hypothesis could be a fracture of trabecular bone with secondary hemorrhage and cystic or fatty degeneration. Alternatively, intramedullary vascular disturbances may lead to foci of bone necrosis that heal by fibroblastic proliferation followed by mucoid or fatty degeneration. It is also possible that giant fatty SNs could represent end stage of giant cystic SNs.     

Growth hormone and body composition in children younger than 2 years with Prader-Willi syndrome

OBJECTIVES: To assess body composition of infants with Prader-Willi syndrome (PWS) by using deuterium dilution and investigating the efficacy of early institution of growth hormone (GH) therapy in increasing lean mass (LM) and preventing massive obesity. STUDY DESIGN: One group of 11 children with PWS <2 years before and during 30-month GH therapy (GH group) was compared with 6 infants administered only coenzyme Q(10) for 1 year (Q10 group). LM adjusted for height (LM(Ht)) and relative fat mass (%FM(Age)) standard deviation scores (SDS) were calculated from data of 95 healthy children. RESULTS: Initially, LM(Ht) of all patients was below the normal average. LM(Ht) decreased by -0.46 +/- 0.3 SD (P=.03) per year in the Q10 group but rose by 0.25 +/- 0.3 SD (P=.02) per year during GH therapy, normalizing after 30 months (-0.70 +/- 1.0 SD). Despite low to normal weight for height (WfH), %FM(Age) was above the normal average (GH group, 31.0% +/- 4.5%, Q10 group, 32.4% +/- 9.5%). In the Q10 infants, %FM(Age) increased by 0.71 +/- 0.7 SD per year, whereas in the GH group, %FM(Age) remained more stable up to 30 months. CONCLUSIONS: Diminished LM(Ht) found in infants with PWS further declines during the early years. Early institution of GH therapy lifts LM(Ht) into the normal range and delays fat tissue accumulation.     

Morphodynamics and Surgical Correction of the Body’s Creases,Folds, and Wrinkles

The aesthetics of the human body are a balance of furrows and orifices, and artists of every period have studied the distance between ear and eye, eye and nostrils, nostrils and mouth, nipple and submammary crease, subgluteus folds and iliac crest and so on, to create a code for all body proportions. Currently, the ideal of female beauty prefers more elongated shapes than in the past, and surgical body modeling, performed in accordance with anthropometric rules, uses a combination of techniques to alter the orientation and depth of aesthetic reference points, such as body folds and curves. These must be integrated into the bodys biodynamics to both prevent and correct defects and irregularities of the body, which has an inherent disposition to change shape, both because of the physical forces acting on it and because of constant tissue replacement.     

Relationship between body composition and bone mineral density in healthy young and premenopausal Chinese women

This study investigated the relative contribution of fat mass and lean mass to bone mineral density (BMD) in young and premenopausal healthy Chinese women. The study was performed in 282 young and premenopausal healthy women with regular menstrual cycles. The BMD at lumbar spine (L2–L4), total hip and total body, together with fat mass and lean mass were assessed by dual-energy X-ray absorptiometry (DXA); body height, weight, waist and hip circumference were also measured, and body mass index (BMI) and waist-hip ratio were calculated. Fat mass was a major determinant for BMI, BMI and lean mass were positively related to L2–L4, total hip and total body bone density (P<0.001 for all), lean mass was the only independent factor contributing to BMD at L2–L4 (standardized coefficient =0.282, P<0.001), total hip (=0.336, P<0.001) and total body (=0.361, P<0.001) in multiple stepwise regression analysis. The correlation between BMI and BMD was improved after adjustment for fat mass, while decreased or even lost when lean mass was adjusted. These data suggested that in the Chinese population, lean mass is an important factor determining BMD in young and premenopausal women.     

Fatty acid oxidation and control of food intake

Fatty acid oxidation is thought to play a role in the control of food intake, and a low postprandial oxidation of ingested fat may contribute to the overeating on a high-fat diet. Evidence for a role of fatty acid oxidation in control of food intake is mainly derived from the stimulation of feeding in response to administration of the acyl-CoA-dehydrogenase inhibitor mercaptoacetate (MA) and other inhibitors of fatty acid oxidation in different species (rat, mouse, man). Denervation studies suggest that this "lipoprivic feeding" is related to changes in hepatic fatty acid oxidation. In contrast to the strong case for a feeding stimulatory effect of an inhibition of fatty acid oxidation, the evidence for a feeding suppressive effect of a stimulation of fatty acid oxidation is inconsistent and comparatively weak. Ingestion of medium-chain fatty acids (MCFA) and peripheral administration of substances known to increase fatty acid oxidation, such as the fatty acid synthase inhibitor C75 and beta3-adrenergic agonists, decrease feeding. Yet, these substances also reduce the rats' usual preference for saccharin solution, indicating that the feeding suppressive effect is not only due to a stimulation of fatty acid oxidation. A possible approach to answer the question of whether a stimulation of hepatic fatty acid oxidation enhances satiety is to selectively increase expression and activity of the enzyme CPT 1alpha in the liver. CPT 1alpha transfers long-chain fatty acids in the cytosol from CoA to carnitine, which is the precondition for the entry of long-chain fatty acids into mitochondria and the rate-controlling step in mitochondrial fatty acid oxidation. The generation of rats with inducible, liver-specific overexpression of CPT 1alpha should permit to critically examine the putative contribution of hepatic fatty acid oxidation to the control of food intake.     

Low-dose growth hormone and human immunodeficiency virus-associated lipodystrophy syndrome: a pilot study

BACKGROUND: Treatment with high doses (2-6 mg day(-1)) of human growth hormone (hGH) in patients with human immunodeficiency virus (HIV)-associated lipodystrophy syndrome (HALS) has been shown to increase concentrations of total insulin-like growth-factor-I (IGF-I) more than twofold greater than the normal upper range and is accompanied by adverse effects such as joint pain and glucose intolerance. MATERIALS AND METHODS: We performed a 16-week open-labelled prospective pilot study in six male HALS patients using a s.c. low-dose hGH, 0.7 mg day(-1), aiming to examine the impact on total and free IGF-I and fat distribution. Glucose metabolism was examined by oral glucose tolerance tests and hyperinsulinaemic euglycaemic clamps. RESULTS: Total IGF-I increased twofold (P < 0.01) and free IGF-I increased 2.5-fold (P < 0.01) to the level of the normal upper range. HDL-cholesterol increased (P = 0.01). Patients reported improvements of lipodystrophy, which was supported by a decreased waist-to-thigh ratio (P = 0.01), and waist-to-hip ratio (P = 0.06). Ratio of peripheral to trunk soft tissue mass increased (P = 0.01, measured by dual-energy X-ray absorptiometry scans) and a trend towards reduction in percentage of trunk fat was suggested (P = 0.12). Total fat mass, exercise capacity, glucose tolerance, glucose disposal rate and immune status, respectively, did not change (all P > 0.5). The patients did not complain of arthralgia or other known GH-related side-effects. CONCLUSIONS: Sixteen weeks' treatment of lipodystrophic HIV-infected patients with hGH, 0.7 mg day(-1), increased total and free IGF-I twofold and appeared safe and tolerable. The potential of low-dose hGH in the treatment of HIV-lipodystrophy awaits examination by placebo-controlled, randomized trials.