withdrawn 2017 hrs ehra ecas aphrs solaece expert consensus statement on catheter and surgical ablation of atrial fibrillation

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Abdominal and Thigh Muscle Attenuation Is Associated With Visceral Fat and Age in Children and Adolescents With Obesity

Objective . This study investigated relationships between adipose tissue deposition within skeletal muscle and morphological and biochemical variables in children with obesity. Methods . Fifty-one Japanese children (16 girls) aged 7 to 16 years were assigned to either mild (<20%), moderate (≥20% to <50%), or severe obesity groups (≥50%). Computed tomography images were taken to calculate the cross-sectional area (CSA) of muscle, subcutaneous and visceral adipose tissue (VAT, for abdomen only), and muscle signal intensities, as an index of intramuscular adipose tissue in the anterior, lateral, and posterior muscles of the abdomen and quadriceps, hamstring and adductor muscles in the thigh. Fasting blood samples were collected to measure plasma lipids, glutamate oxaloacetate transaminase, glutamate oxaloacetate transaminase, uric acid, glucose, and HbA1c. Results . Signal intensity in the severe obesity group was significantly lower than mild and moderate obesity groups in the abdomen and significantly lower than the moderate obesity group in the thigh. Stepwise regression analysis with signal intensity as dependent variable revealed that VAT CSA and age in abdominal muscles and VAT CSA, age, and triglycerides in thigh muscles are predictors of signal intensities. Conclusions . These results suggest that VAT CSA and age are predictors of intramuscular adipose tissue of the abdominal and thigh in children with obesity

Signet Ring Cell Carcinoma of the Extrahepatic Bile Duct Diagnosed by Preoperative Biopsy: A Case Report

A 73-year-old woman was admitted because of obstructive jaundice. Computed tomography revealed a stricture in the lower bile duct with enhanced bile duct wall. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a tapering stenosis at the lower bile duct. Transpapillary histological biopsy using biopsy forceps through ERCP was performed; the diagnosis of signet ring cell carcinoma (SRCC) of the bile duct was established. Regional lymph node enlargement and distant metastases were not detected on diagnostic imaging. Pancreaticoduodenectomy with pylorus preservation was performed. Histological examination of the resected specimen confirmed SRCC of the extrahepatic bile duct coexisting with adenocarcinoma (ADC) of the extrahepatic bile duct with negative resection margins. However, tumor cells directly invaded the pancreatic parenchyma and the muscle layer of the duodenum, prompting us to administer adjuvant chemotherapy to the patient, with no sign of tumor recurrence at 1-year follow-up. Almost all tumors originating from the extrahepatic bile duct are ADC and other histological variants are rare. Of these, SRCC is extremely rare and only four cases have been reported. Furthermore, to the best of our knowledge, this is the first case report regarding the preoperative diagnosis of SRCC of the bile duct. Current reports indicate that younger age and Asian ethnicity are the clinical features of SRCC of the extrahepatic bile duct. Immunohistochemical staining of CK7, CK20 and MUC2 may be useful for predicting prognosis. Chemotherapy has not resulted in increased survival rates and only surgical resection currently serves as a curative treatment