Abraham A. Ghiatas

Total Body Fat Content and Fat Topography Are Associated Differently With In Vivo Glucose Metabolism in Nonobese and Obese Nondiabetic Women

In this study, total body fat content and fat topography were related to glucose metabolism in the basal and nsulin-stimulated states in 18 nonobese and 18 obesepremenopausal nondiabetic women. All subjects received a euglycemic insulin (20 mil · min−1 · m2) clamp study in combination with [3-3H]-D-glucose infusion and indirect calorimetry to quantitate total body glucose uptake, glucose oxidation, and nonoxidative glucose disposal. Total body fat content was determined with tritiated water, whereas body fat distribution was estimated from the WHR, the STR, and the VSR (measured by magnetic resonance imaging). In the postabsorptive state, total body glucose utilization, glucose oxidation, and nonoxidative glucose disposal rates were similar in nonobese and obese women, whereas during the insulin clamp all three metabolic parameters were reduced significantly in the obese group. In nonobese women, total body fat content was related inversely to both total and nonoxidative glucose disposal during the insulin clamp, whereas no relationship was found between glucose metabolism (total, oxidative, and nonoxidative) and WHR, STR, or VSR. In contrast, in obese women, no relationship was observed between total body fat content and any measure of insulin-mediated glucose metabolism. However, both WHR and VSR were related inversely to total, oxidative, and nonoxidative glucose disposal rates during the insulin clamp. These results suggest that total body fat content and body fat topography are associated differently with insulin-mediated glucose metabolism in nonobese and obese women. In the nonobese women, total body fat mass appears to be a primary determinant of tissue sensitivity to insulin, whereas in obese women, body fat topography exerts a more dominant effect.

Virulent diverticular disease in young obese men

Recent treatment of young patients (aged 40 years or less) with complicated diverticulitis prompted us to review our experience. During a 9-year period ending in December 1990, 61 of 238 patients treated for acute diverticulitis were 40 years of age or younger. The younger patients were primarily obese Hispanic males in whom the correct diagnosis was frequently missed. Younger patients more frequently required an operation on an urgent basis for complications of diverticulitis during the initial hospitalization. The most common indication for operation in young patients was perforation compared with recurrent disease for the older age group. The younger group had a sevenfold incidence of enteric fistulas complicating their acute episode of diverticulitis. Our data suggest that diverticular disease in young patients is more common and more likely to require early surgical intervention than previously noted. In addition, obesity may represent an important etiologic factor in the development of diverticular disease.

Systematic Transrectal Ultrasound Guided Prostate Biopsy After Negative Digitally Directed Prostate Biopsy

The diagnostic accuracy of digitally directed prostate biopsies was evaluated by performing systematic ultrasound guided biopsies on 44 patients who had previously had a negative prostate biopsy by systematic digitally directed technique. All 44 patients still had palpable abnormalities. Core biopsies (2 to 4) were obtained from each lateral lobe of the prostate with 2 additional cores directed at hypoechoic lesions. Only 4 of the 44 ultrasound directed biopsies (9.1%) were positive for cancer. These results confirm the postulate that random systematic digitally directed biopsy is highly accurate in making the diagnosis of prostate cancer. They also suggest that performing biopsies in a systematic pattern is more important than the method used to guide the biopsy needle.

Computed tomography of the normal appendix and acute appendicitis

Abstract The aim of this article is to present pictorially the spectrum of appearances of the appendix and appendicitis on CT. The images presented were selected from the database of our hospitals. The various appearances of the normal appendix on CT are shown. Appendicitis can be divided into four categories on the basis of CT findings. Examples of each category are shown.

Sonographic findings in cases of missed gallstones

We retrospectively evaluated sonographic findings in 946 cases of gallstones to determine whether the false‐negative rate for gallstone detection by sonography has decreased as a result of technologic advances over the past 15 years.

CT of spontaneous haematoma of the omentum

Omental haematoma is usually the result of abdominal trauma. We present the CT findings in a patient who presented with a spontaneous omental haematoma. To our knowledge no previous case has been reported.

Subcutaneous soft tissue densities: A computed tomography indicator of severe pancreatitis

Twenty patients with known acute pancreatitis had 50 computed tomography studies. Those with severe pancreatitis showed streaky and fluffy soft tissue densities in the flanks and some in the gluteal regions. The appearance and disappearance of this finding correlates with the extravascular movement of fluid due to severe pancreatic inflammation.

Prostatic abscess: CT and sonographic features

Prostatic abscess is not a common condition, but delay in the diagnosis may result in serious complications such as rupture of the abscess into the rectum or urethra resulting in a high morbidity. We present a case of clinically unsuspected prostatic abscess where computed tomography and transrectal sonography established the diagnosis.

Modified localization wire for breast lesions

We modified commercially available wires for localization of non-palpable breast leasions. The modified localizing wire was used in 16 women requiring excision of non-palpable breast lesions and comparison was made with non-localizing wires. The results indicated that the modified localizing wire provided technical ease to the surgeons in removing the breast lesion and significant help to the radiolgists in placing the wire and reporting the position of the wire in relation to the breast lesion.