Fatty Atrophy

Fig. 10.47a-c. Ape hand deformity in the right hand of a patient with severe median neuropathy at the carpal tunnel level, a Photograph of the palmar aspect of the hand reveals a skin depression (arrows) due to loss in bulk of the intrinsic muscles at the thenar eminence, b Transverse 12-5 MHz US image at the dorsal aspect of the hand demonstrates a hyperechoic appearance of the abductor pollicis brevis (asterisk) and opponens poUicis (star) related to neurogenic fatty atrophy, d Contralateral healthy side. The insert at the upper right side of the figure indicates probe positioning... 

Fig. 13.22a-d Normal and pathologic states of the distal aponeurosis of the rectus femoris. a Normal muscle. Schematic drawing of a midsagittal view over the distal rectus femoris illustrates the orientation that the fibers from the outer (gray dashed arrows) and the inner (white dashed arrows) muscle assume to reach the distal aponeurosis. The distal rectus femoris ends with a typical pointed appearance, b Distal aponeurosis tear. The most distal portion of the rectus femoris muscle is retracted and has a swollen blunted end as a result of avulsion (curved arrow) from the distal aponeurosis. Note the distal hematoma (black area), c Chronic tear of the distal aponeurosis. The muscle has a decreased size and reflecting fatty atrophy. Fibrous tissue (light grey) has replaced the blood collection, d Small partial tear. A small partial tear located at a more proximal level appears as a focal avulsion (black area) of some muscle flbers... 

Phosphoenolpyruvate carboxykinase (PEPCK) deficiency is distinctly rare and even more devastating clinically than deficiencies of glucose-6-phosphatase or fructose-1,6-bisphosphatase. PEPCK activity is almost equally distributed between a cytosolic form and a mitochondrial form. These two forms have similar molecular weights but differ by their kinetic and immunochemical properties. The cytosolic activity is responsive to fasting and various hormonal stimuli. Hypoglycemia is severe and intractable in the absence of PEPCK [12]. A young child with cytosolic PEPCK deficiency had severe cerebral atrophy, optic atrophy and fatty infiltration of liver and kidney. 

Fig. 30. Thirteen-year-old boy with desmin storage myopathy, (a) The T weighted image shows an atrophy of the tibialis anterior muscle (with the volume element indicated) and a fatty degeneration of the soleus muscle (arrow), (b) The spectrum from the tibialis anterior muscle shows prominent EMCL. TMA is reduced as indicated in the area of the 5-fold magnification.

Injection of animal insulin preparations sometimes led to atrophy of subcutaneous fatty tissue at the site of injection. This type of immune complication is almost never seen ever since the development of human and analog insulin preparations of neutral pH. Injection of these newer preparations directly into the atrophic area often results in restoration of normal contours. 

Hepatic Effects. No hepatic effects were reported in humans from exposure to low doses of diazinon by any route. Hepatic effects reported in human studies were associated with acute high levels of diazinon such as are found in suicide attempts (Limaye 1966). The acute- and intermediate-duration oral exposure to diazinon in animals reduced the activity of a variety of hepatic enzymes (Anthony et al. 1986 Mihara et al. 1981). Liver pathology has also been observed in animals following chronic oral exposure to diazinon. The pathological changes reported in one study included fatty infdtrations, parenchymal atrophy,... 

Gn pig (NS) 35 wk 2 or 4x/wk (GO) Hepatic 0.75 (moderate to marked fibrosis, parenchymal fatty metamorphosis, slight bile duct proliferation, hypertrophy, atrophy) Ashburn et al. 1948... 

Samples should be evaluated for muscle fiber diameters (and the uniformity of fiber sizes), centrally located myonuclei (a sign of a regenerated muscle fiber), fibrosis, fatty infiltration, and atrophied muscle fibers. 

Adverse effects observed with insulin Note lipodystrophy is a local atrophy or hypertrophy of subcutaneous fatty tissue at the site of injections. 

Ultrasound can be used to estimate the size of the liver. A small atrophied nodular liver suggests cirrhosis, and a large hypertrophied liver is inflamed or fatty. Liver lesions can be visualised, which may be malignant and large enough to affect the function of the remaining cells. 

Biotin deficiency and the functional deficiency associated with lack of holo-carboxylase synthetase (Section 11.2.2.1), or biotinidase (Section 11.2.3.1), causes alopecia (hair loss) and a scaly erythematous dermatitis, especially around the body orifices. The dermatitis is similar to that seen in zinc and essential fatty acid deficiency and is commonly associated with Candida albicans infection. Histology of the skin shows an absence of sebaceous glands and atrophy of the hair follicles. The dermatitis is because of impaired metabolism of polyunsaturated fatty acids as a result of low activity of acetyl CoA carboxylase (Section 11.2.1.1). In biotin-deficient experimental animals, provision of supplements of long-chain 6 polyunsaturated fatty acids prevents the development of skin lesions (Mock et al., 1988a, 1988b Mock, 1991). 

Fig. 16.7 Massive refractory ascites with large umbilical hernia. Muscular atrophy and loss of subcutaneous fatty tissue...

Liver size The liver may have normal size or it can be enlarged due to hyperaemia or massive fatty infiltration. A rapid shrinking of the liver to less than 1000 ml in volume ( dystrophy , acute atrophy ) - requiring sonographic or CT monitoring at the bedside - is deemed to be a poor prognostic sign. 

The energy supply required by cirrhotic patients is achieved by mobihzing fats the patient s fatty tissue is reduced and body weight decreases the continuing energy requirement is met by the breakdown of muscle proteins with the result that amino adds are formed, which in turn are used for gluconeogenesis in the liver. Catabolism increases and leads to muscular atrophy, which is known as wasting syndrome. (29, 32, 62, 86, 104, 116, 117, 126)... 

Polymyositis can occur as a primary disease or a paraneoplastic syndrome. Clinically, there is weakness and pain in the shoulder and hip musculature, with muscular atrophy. Laboratory parameters show greatly elevated inflammatory criteria (s. tab. 38.2) as well as a rise in myosin AB. Liver involvement is characterized by hepatomegaly, inflammatory infiltration of the portal fields, fatty changes in the liver cells and single-cell necrosis as well as necrotic foci. 

Whether dietary fiber is required for the health of the colonocylcs has not been proven, although evidence suggests such a requirement Absorption of salts and water is a major function of the large intestine. Short-chain fatly adds stimulate the absorption of sodium, chloride, and water in the colon (Hoverstad, 1986). in the absence of short-chain fatty acids, the mucosa of the colon may become inflamed or atrophied. 

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