RESUMO A quantificação da adiposidade visceral é de suma importância, pois a gordura visceral é a grande responsável pelas complicações metabólicas da população obesa. O método de escolha para tal quantificação é a Tomografia Computadorizada. No entanto, este exame tem alto custo, é pouco prático e submete os indivíduos aos riscos da irradiação. A medida de cintura, a relação cintura-quadril e o diâmetro sagital são métodos que determinam indiretamente a gordura visceral. A ultra-sonografia tem sido proposta como uma técnica não invasiva para a avaliação de gordura intra-abdominal. No presente estudo foram determinadas, através da ultra-sonografia, as espessuras subcutâneas e intra-abdominais em 29 mulheres obe-sas em pré-menopausa. Estes valores foram comparados com os parâmetros antropométricos e com as áreas subcutâneas e viscerais medidas pela tomografia computadorizada. A espessura intra-abdominal foi a variável que obteve maior coeficiente de corre-lação com as áreas adiposas viscerais. Para a equação preditiva de área visceral, além da espessura intra-abdominal, foram incluídas as variáveis espessura subcutânea e medida de cintura. A espessura intra-abdominal mostrou correlação significativa com os níveis ten-sionais e com os valores de triglicerídeos. A correlação entre a ultra-sonografia e a tomografia computadorizada foi maior no grupo onde as áreas viscerais eram maiores. A ultra-sonografia é um méto-do útil para a determinação do tecido adiposo visceral. (Arq Bras Endocrinol Metab 2000; 44/1: 5-12) Unitermos: Obesidade visceral; Diagnóstico; Ultra-sonografia ABSTRACT The measurement of visceral adipose tissue is very important as the visceral fat plays a major role in the metabolic disorders of the obese people. Computed tomography is the reference method for intra-abdominal fat evaluation, but it is expensive, with fairly limited availability and employs ionizing radiations. Waist circumference, waist/hip ratio and sagittal diameter are considered representative measurements of visceral fat. However they remain indirect means for calculating intra-abdominal adipose deposits. Sonography has been proposed as a noninvasive technique for measuring visceral fat. In this study subcutaneous and intra-abdominal thickness were measured by sonography on 29 premenopausal obese females. The results were compared with the anthropometric methods and with the subcutaneous and visceral adipose tissue areas measured by computed tomography. Ultrasound intra-abdominal thickness was the variable with highest correlation coefficient with visceral fat areas. In the predictive equations for visceral adipose tissue area besides intra-abdominal thickness, subcutaneous fat thickness and waist circumference was included. The intra-abdominal thickness

Smaller pancreases in IDDM patients in comparison with NIDDM patients and control subjects were clearly demonstrated only after 10 yr of disease. Patients with NIDDM were not affected by pancreatic dimensions, except for a greater body thickness after 10 yr of disease. Pancreatic echogenicity increased with age.

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For the purpose of shedding some light upon the possible mechanisms involved in gallstone formation in patients with Crohn’s disease, we have investigated gallbladder emptying by means of ultrasonography in two groups of subjects: controls (n = 40) and Crohn’s disease (n = 30). Diminished gallbladder emptying after a liquid fatty-meal stimulus was observed in patients with Crohn’s disease when compared with controls (p < 0.001). Also, the values for the residual gallbladder volume (RGV) and maximal decrease in gallbladder volume (MDGV), both in milliliters and percentage were, respectively, increased (RGV = 9.6 ml) and diminished (MDGV = 14.8 ml; MDGV = 60.9%) in patients with Crohn’s disease when compared with controls (RGV = 5.9 ml, p < 0.001; MDGV = 19.9 ml, p = 0.003; MDGV = 77.8%, p < 0.001). Hence, reduced gallbladder emptying with consequent stasis might be a contributory factor to the increased prevalence of gallstones in Crohn’s disease.

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In order to gain insight into the possible mechanisms involved in gallstone formation in colectomized ulcerative colitis patients, we studied gallbladder motility by means of ultrasonography in three groups of subjects: controls (N = 40) and ulcerative colitis patients without (N = 30) and with (N = 20) colectomy. Impaired gallbladder emptying after a liquid fatty meal stimulus was observed in ulcerative colitis patients with colectomy compared with those obtained in ulcerative colitis patients without colectomy and controls (P = 0.001). The maximum percentage of gallbladder emptying also, was significantly lower (59.8%) than those seen in ulcerative colitis patients without colectomy (74.5%) and controls (77.8%) (P = 0.001). Diminished gallbladder emptying with ensuing stasis might be a contributory factor to the increased prevalence of gallstones in colectomized patients.

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Early allograft dysfunction after liver transplantation is an important cause of allograft loss. There is a lack of data on applicability of liver stiffness measurement (LSM) by elastography in early post-liver transplantation that can predict these complications. Our aim was to evaluate the diagnostic accuracy of elastography to predict early allograft dysfunction or loss after liver transplantation. Sixty-one liver transplant patients were prospectively enrolled and underwent daily LSM over the first seven post-operative days. Early allograft dysfunction and loss occurred in 27 (44.2%) and 17 (27.8%) patients, respectively. C-statistic of each day of LSM showed high accuracy and no significant difference between them. For early allograft dysfunction, LSM>2.39m/s on the first day had c-statistics=0.83, sensitivity=0.41, specificity=0.97, positive predictive value=0.92, negative predictive value=0.67, positive likelihood ratio=13.85 to rule in, while a LSM<1.65m/s had c-statistics=0.83, sensitivity=0.96, specificity=0.50, positive predictive value=0.60, negative predictive value=0.94, negative likelihood ratio=0.07 to rule out. For early allograft loss, LSM>2.25m/s had c-statistics=0.93, sensitivity=0.76, specificity=0.98, positive predictive value=0.93, negative predictive value=0.91, positive likelihood ratio=33.65 to rule in, while a LSM<1.75m/s had c-statistics=0.93, sensitivity=0.94, specificity=0.94, positive predictive value=0.50, negative predictive value =0.97, negative likelihood ratio=0.09 to rule out. These results were internally validated with the bootstrap method. No methods (Olthof criteria, MELD, MELD-5, MEAF, BAR, biomarkers) performed better than elastography to predict early allograft loss. Elastography performed over the first week after liver transplantation can accurately predict early dysfunction and allograft loss.