Objective: Increased thyroid-stimulating hormone (TSH) and FT 3 levels are often found in clinically euthyroid obese individuals. Information on thyroid gene expression in human adipose tissue is scarce. The objective of this study was to measure the expression of the TSH receptor (TSHR) and the thyroid hormone receptor (TRa1) genes in subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) in obese individuals and to test the effect of weight loss on these genes. Study Design and Participants: This study is a prospective study involving 107 obese (body mass index (BMI) ¼ 46±8 kg m À2 , 52 with type 2 diabetes or impaired glucose tolerance) and 12 lean nondiabetic participants. A total of 27 obese patients were restudied 1 year after gastric bypass surgery. Total RNA was extracted from SAT and VAT obtained at baseline from all participants, and from SAT in obese patients post surgery. Results: Circulating TSH and FT 3 levels were 170 and 36%, respectively, higher in obese patients than in controls. In SAT, TSHR and TRa1 were reduced in the obese by 67 and 33%, respectively, regardless of glucose tolerance. A similar trend was found in VAT. Post surgery, a BMI decrease of 33% was associated with a decrease in TSH and FT 3 levels and with a 150 and 70% increase in SAT of TSHR and TRa1, respectively. Conclusion: In both subcutaneous and visceral fat, the thyroid gene expression (especially TSHR) is reduced in obesity. The reversal of these changes with major weight loss and the reciprocal changes in plasma TSH and FT 3 levels suggest a role for adipocytes in the regulation of TSH and thyroid hormones.

To evaluate ultrasound (US) versus conventional plain film radiography (CPF) in the detection of pneumoperitoneum, 30 patients with postsurgical pneumoperitoneum and a control group of 22 patients were studied using US and CPF. Sonograms and radiograms were obtained while patients were supine and in left lateral decubitus. The two orthogonal plain films of the abdomen were acquired with a horizontal X-ray beam. The epigastric region and right hypochondrium were investigated with ultrasonography. Four experienced, blinded radiologists examined 160 sonograms and 104 radiograms. Statistical analysis yielded a sensitivity of 75.7% for radiography versus 86% for ultrasonography, a specificity of 89.2% versus 83.5%, an accuracy of 81.5% versus 85%, a positive predictive value of 90.2% versus 87%, and a negative predictive value of 76.2% versus 83.5%, respectively. US could therefore be considered a reliable alternative imaging technique in the detection of pneumoperitoneum.

MRC is a highly effective diagnostic modality for evaluation of patients with risk factors for CBD stones prior to LC.

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