Resting energy expenditure (REE) and components of fat-free mass (FFM) were assessed in 26 healthy nonobese adults (13 males, 13 females). Detailed body composition analyses were performed by the combined use of dual-energy X-ray absorptiometry (DEXA), magnetic resonance imaging (MRI), bioelectrical impedance analysis (BIA), and anthropometrics. We found close correlations between REE and FFM(BIA) (r = 0.92), muscle mass(DEXA) (r = 0.89), and sum of internal organs(MRI) (r = 0.90). In a multiple stepwise regression analysis, FFM(BIA) alone explained 85% of the variance in REE (standard error of the estimate 423 kJ/day). Including the sum of internal organs(MRI) into the model increased the r(2) to 0.89 with a standard error of 381 kJ/day. With respect to individual organs, only skeletal muscle(DEXA) and liver mass(MRI) significantly contributed to REE. Prediction of REE based on 1) individual organ masses and 2) a constant metabolic rate per kilogram organ mass was very close to the measured REE, with a mean prediction error of 96 kJ/day. The very close agreement between measured and predicted REE argues against significant variations in specific REEs of individual organs. In conclusion, the mass of internal organs contributes significantly to the variance in REE.

Compared with the results of previous studies using functional cervical myelograms, kinematic magnetic resonance imaging provides additional noninvasive data concerning the physiologic changes of the cervical subarachnoid space and the cervical cord during flexion and extension in healthy individuals.

Magnetic resonance imaging identified a significant percentage of increased spinal stenosis at flexion and, especially, at extension, which was not observed at neutral position (0 degree). Flexion and extension MR imaging demonstrates additional information using a noninvasive technique concerning the dynamic factors in the pathogenesis of cervical spondylotic myelopathy.

The purpose of this study was to evaluate diagnostic MRI criteria in Wegener's granulomatosis of the nasal cavity, the paranasal sinuses and orbits. Between March 1991 and January 1996, 62 patients with biopsy-proven Wegener's granulomatosis were studied with T1- and T2-weighted spin-echo (SE) sequences. In 32 patients coronal postcontrast T1-weighted images were obtained. Mucosal thickening of the nasal cavity and paranasal sinuses was demonstrated as high-intensity lesions on T2-weighted SE sequences in 57 patients (92%). Of this group, inflammatory granulomatous tissue was found on biopsy in 30 patients (48%) in the nasal cavity and in 4 patients (6%) in the paranasal sinuses. In 23 patients (37%) biopsy revealed unspecific inflammatory changes without evidence of granulomatous tissue. In 14 patients (23%) granulomas were depicted as low-signal intensity lesions on T1- and T2-weighted SE sequences in the paranasal sinuses and orbits. In 5 patients (8%) osseous destruction was found. After gadolinium injection, 12 of 14 granulomas showed inhomogeneous signal enhancement. In two granulomas no enhancement was found. The MRI technique is helpful in the diagnosis of patients with Wegener's granulomatosis. In the initial inflammatory process of Wegener's granulomatosis, it is not possible to differentiate between mucosal inflammation and granulomatous tissue in MRI. In the later stage of granulomatous transformation, granulomas can be depicted as low-signal-intensity lesions. Therefore, Wegener's granulomatosis should be included in the differential diagnosis of patients with low-signal-intensity lesions on T1- and T2-weighted SE sequences of the nasal cavity, paranasal sinuses and orbits.

Kinematic MR imaging adds additional information when compared to conventional imaging methods in patients with advanced stages of degenerative disease of the cervical spine.

The purpose of this study was to evaluate our capability to use coronally acquired. cardiac-gated two-dimensional phase-contrast MR angiography (MRA) to correctly detect and grade arteriosclerotic lesions from the aortic bifurcation to the popliteal artery. SUBJECTS AND METHODS. One hundred fifteen patients with a total of 253 arteriosclerotic lesions proven by intraarterial digital subtraction angiography were examined prospectively by two-dimensional phase-contrast MRA. MRA was perfirmed from the aortic bifurcation to the popliteal trifurcation. Imaging paranleters were TRITE. 83/9 msec; flip angle, I 1#{176}; matrix. 256 x 192: acquisitions. two; slice thickness. 80 mm: and field of view. 320 mm. ECG gating was used routinely and eight to 10 phases were acquired during the cardiac cycle. Velocity encoding was set to 30 cmlsec in the iliac arteries and to 20 em/sec in the femoral and popliteal arteries. Detected stenoses were graded in the following manner: I e4, to less than 50% stenosis, group 1 : 50 7c to less than 7SCk stenosis, group 2: 7SCk to less than I00% stenosis. group 3: and total occlusion, group 4. RESULTS. All arteriosclerotic lesions were revealed by MRA. Two hundred seventeen of 253 lesions were also graded correctly. Sensitivity was 95%, specificity was 90%. positive predictive value was 90%. and negative predictive value was 96%. The weighted kappa index was .92. Sensitivity and specificity for occlusions were both 1OO % ; for high-grade stenoses. 94% and 91 C4 respectively: for moderate stenoses. 84C/ and 94C% , respectively: and for mild stenoses. 79'F and lOOck. respectively. CONCLUSION. Two-dimensional phase-contrast MRA can provide MR angiograms with high sensitivity and specificity for high-grade stenoses in a reasonable amount of time in patients with peripheral artery occlusive disease.

This case illustrates that even awake fiberoptic intubation has its failure rate, due to inability to visualize the larynx, inability to advance the tube over the fiberscope (as in the present case), or inability to direct the tube towards the larynx. Due to the extreme deviation of the larynx other established techniques for difficult intubation were not deemed appropriate in this case. Therefore, weighing the risks and benefits, a decision was made to perform a tracheotomy under local anaesthesia.

The evaluation of sensitivity, specificity, and positive and negative predictive value for all APACHE II score points showed that there was not a "golden" cutoff to detect necrotizing pancreatitis. We conclude that the APACHE II score on admission to the hospital is unreliable to diagnose necrotizing pancreatitis.