Autopsy findings for 111 cases of esophageal cancer are presented. Residual tumor in the esophagus was present in 75% of the cases. Lymph node metastases were found in 74.5% and visceral metastases in SWo of the cases. Autopsy revealed a second primary tumor in 21% of the cases; 12% of these were oro-pharyngeal-laryngeal (OPL) carcinomas, and Wo were visceral carcinomas or malignant lymphomas. Nonmalignant disease found in association with esophageal cancer was dominated by conditions related to chronic alcoholism. Autopsy findings thus revealed that the patients bore not only esophageal lesions, but also patterns of other associated malignant and nonmalignant diseases which would seem to correspond to a complex pathologic state occurring in association with chronic alcoholism. The time between onset of symptoms and autopsy averaged 10.6 months and between first consultation and autopsy, 6.3 months. The brevity of survival from onset of symptoms would seem to confirm that by the time esopha-geal cancer manifests clinically, it is already at a stage of development beyond the scope of treatment. Cancer 48329-335. 1981. PIDEMIOLOGIC STUDIES have shown that while the

Insomnia might occur as result of increased cognitive and physiological arousal caused by acute or long acting stressors and associated cognitive rumination. This might lead to alterations in brain connectivity patterns as those captured by functional connectivity fMRI analysis, leading to potential insight about primary insomnia (PI) pathophysiology as well as the impact of long-term exposure to sleep deprivation. We investigated changes of voxel-wise connectivity patterns in a sample of 17 drug-naïve PI patients and 17 age-gender matched healthy controls, as well as the relationship between brain connectivity and age of onset, illness duration, and severity. Results showed a significant increase in resting-state functional connectivity of the bilateral visual cortex in PI patients, associated with decreased connectivity between the visual cortex and bilateral temporal pole. Regression with clinical scores originally unveiled a pattern of increased local connectivity as measured by intrinsic connectivity contrast (ICC), specifically resembling the default mode network (DMN). Additionally, age of onset was found to be correlated with the connectivity of supplementary motor area (SMA), and the strength of DMN←→SMA connectivity was significantly correlated with both age of onset (R2 = 41%) and disease duration (R2 = 21%). Chronic sleep deprivation, but most importantly early insomnia onset, seems to have a significant disruptive effect over the physiological negative correlation between DMN and SMA, a well-known fMRI marker of attention performance in humans. This suggests the need for more in-depth investigations on the prevention and treatment of connectivity changes and associated cognitive and psychological deficits in PI patients.

A study of brainstem auditory evoked potentials (BAEPs) and pattern reversal visual evoked potentials (VEPs), recorded in intercritical phase, was carried out in 20 subjects (10 suffering from common migraine and 10 suffering from vertebrobasilar TIA) in order to obtain a comparative evaluation of cortical-subcortical functions. The data we obtained demonstrate the presence of BAEPs alterations in patients with previous vertebrobasilar TIA: no abnormalities were found in the migraine group. VEPs parameters are normal in both groups. Our data show that the study of the so-called "stimulus-related" potentials, such as BAEPs and pattern reversal VEPs, is useful in evaluating the damage produced by any noxa, while it cannot clearly emphasize individual factors predisposing to a specific pathology, as the absence of specific alterations in migraine patients demonstrates.

■ AbstractAdipose tissue is involved in the regulation of glucose and lipid metabolism, energy balance, inflammation and immune response. Abdominal obesity plays a key role in the development of insulin resistance because of the high lipolytic rate of visceral adipose tissue and its secretion of adipocytokines. Low birth weight subjects are prone to central redistribution of adipose tissue and are at high risk of developing metabolic syndrome, type 2 diabetes and cardiovascular disease. Intrauterine adipogenesis may play a key role in the fetal origin of the pathogenesis of metabolic syndrome, type 2 diabetes and cardiovascular disease. Therefore, knowledge of the behavior of visceral adipose tissue-derived stem cells could provide a greater understanding of the metabolic risk related to intrauterine growth retardation, with potential clinical implications for the prevention of long-term metabolic alterations.Keywords: diabetes · SGA · adipose tissue · glucose metabolism · lipids · insulin resistance · low birth weight Adipose tissue and insulin resistancePathophysiology of visceral adipose tissue: the role of free fatty acids dipocytes are highly specialized cells that maintain whole body energy homeostasis by regulating glucose and lipid metabolism. For a long time, adipocytes have been considered to be an energy depot that stores and mobilizes triglycerides [1]. Recently, adipocytes have also been recognized as an endocrine tissue because of the discovery of several adipocyte-derived molecules, including lipid metabolites and adipocytokines [2].Adipose tissue contains functionally distinct cellular subtypes, the white adipocyte, devoted to energy storage, and the brown adipocyte, which dissipates energy through thermogenesis. In the rat, brown adipose tissue is the major site of heat production. Brown fat also plays a major role in heat production in the neonates of many mammalian species. Its quantitative contribution to energy metabolism at maturity in large mammals, including humans, is uncertain. The storage of triglycerides and fatty acids in white adipose tissue occurs through the ability of insulin to stimulate significantly both glucose uptake and lipogenesis. Defects in fuel partitioning into adipocytes either because of increased adipose mass or increased circulating free fatty acids, results in dyslipidemia, obesity, insulin resistance and type 2 diabetes [3].The association between type 2 diabetes and obesity is well established. Several studies have docu-

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