cirrhotic patients undergoing LTx are not well investigated. 1,2 The clinical relevance of malnutrition and hypermePatients with fulminant hepatic failure, patients over 40 tabolism in end-stage liver disease, as well as their efyears of age with postnecrotic cirrhosis, patients with maligfects on survival after liver transplantation (LTx), are nant disease, children with malnutrition, and hepatitis B largely unknown. This study investigates the prognostic and delta virus carriers have been suggested to have inferior value of nutritional and metabolic parameters obtained survival after LTx. [3][4][5][6][7][8] In addition, some dynamic tests like before LTx for survival after LTx. One hundred fifty pathe monoethylglycinexylide test, plasma amino acid levels tients with end-stage liver disease undergoing LTx were and clearance, the branched-chain to aromatic amino acid assessed prospectively and followed for a mean period ratio, and the arterial ketone body ratio have been shown to of 46 { 16 months after LTx. All patients were randomhave some prognostic value in patients undergoing LTx. 9 ized into a study group and a validation group, each However, the consequences of malnutrition and hypermecomprising 75 patients. Body composition analysis (24-tabolism on the liver transplantation patient have not been hour urinary creatinine excretion, anthropometry, bioadequately addressed in clinical studies. Malnutrition is a electrical impedance analysis), deviation of measured common finding in patients with advanced liver disease, and from predicted resting energy expenditure (DREE), most transplantation candidates show at least mild nutriyear of transplantation, and several variables known to tional depletion at the time of initial evaluation. 9,10 Although be of prognostic relevance in patients with liver disease individual nutritional parameters lack sensitivity in patients undergoing conservative treatment were analyzed.with end-stage liver disease, it is known that protein calorie Kaplan-Meier and log rank analysis showed that hypermalnutrition is widely prevalent in these patients. 11,12 metabolic patients (DREE ú /20%) and patients with a Clinical evaluation of nutritional status was associated body cell mass (BCM) õ 35% of body weight tended to with outcome after abdominal surgery and survival after LTx have reduced survival after LTx. A risk profile on the in studies by Garrison and Shaw. 13,14 The only reported risk basis of DREE and BCM identified patients with high score for 6-month survival after LTx by Shaw et al. considrisk (5-year survival rate, 54%) and low risk (5-year surered malnutrition as a potentially reversible component. 14 A vival rate, 88%; P õ .01). The predictive power of this drawback of the Shaw equation is that his malnutrition score risk profile was independent of the presence of ascites is based on subjective assessment rather than objective criteand clinical edema, and its validity was confirmed in the ria. Our study investigates the use of objective nutritional validation group (P õ .0...

Hypermetabolism has no association with clinical data and thus is an extrahepatic manifestation of liver disease. Increased beta-adrenergic activity may explain approximately 25% of hypermetabolism.

Background and Purpose-The pathophysiology of hypoglycemia shares a common mechanism with cerebral ischemia, but so far, little is known regarding MRI of humans with hypoglycemia. Methods-We report a patient with left hemiparesis and dysarthria associated with a blood glucose level of 1.7 mmol/L.The patient recovered completely after glucose infusion. Results-The initial diffusion-weighted imaging (DWI) showed increased signal intensities and a reduction of apparent diffusion coefficient (ADC) values localized in the corpus callosum (splenium) and asymmetrically in the corona radiata. After 48 hours, follow-up revealed complete recovery of DWI and ADC signal abnormalities. Conclusion-To our knowledge, this is the first presentation of a case with transient hypoglycemia-induced focal neurological deficits revealing completely reversible MRI changes in terms of disturbed DWI and ADC with a peculiar as yet undescribed topography. (Stroke. 2005;36:e20-e22.)

The aim of this study was to evaluate the potential of magnetic resonance mammography (MRM) to distinguish inflammatory breast carcinomas (IBC) from acute mastitis (AM). This study compared MRM examinations of two selected groups of patients: 48 subjects with IBC and 42 patients with AM. No statistical differences were revealed between the two groups for morphology of masses and of non-mass-like enhancement, breast enlargement, diffuse skin thickening, abnormal nipple configuration, prominent vessels, and also for cutaneous/subcutaneous, perimamillar and diffuse oedema. However, initial and postinitial dynamic characteristics significantly differed between the two groups (p < 0.001). In IBC, more masses with a greater average size were detected (p < 0.05). The following morphological criteria were also observed more often in IBC (p < 0.05): T2-hypointensity of masses (77.5%/18.2%), blooming sign (62.5%/31.8%), infiltration of pectoralis major muscle (interruption of fat plane: 54.2%/16.7%; pathological enhancement: 33.3%/7.1%), perifocal (66.7%/33.3%), prepectoral (72.9%/31.0%) and intramuscular pectoral oedema (41.7%/7.1%). The main localisation of AM was subareolar, of IBC central or dorsal (p < 0.001). The discrimination between AM and IBC remains a diagnostic challenge because of overlapping imaging features. However, the combination of multiple dynamic and morphological MRM criteria seems to have the potential for a differential diagnosis.

The BonAge device demonstrates the ability of ultrasound to produce an accurate assessment of bone age. The results are highly correlated with skeletal age evaluated conventionally using the G and P method. Obvious advantages of the ultrasound device are objectivity, lack of ionizing radiation, and easy accessibility.

Objective. To evaluate digital x-ray radiogrammetry (DXR) and the Radiogrammetry Kit program as new diagnostic tools for quantifying disease-related periarticular osteoporosis and for measuring joint space narrowing according to the severity and duration of rheumatoid arthritis (RA).Methods. Using DXR, we performed computerized calculations of bone mineral density (BMD) and the metacarpal index (MCI) in 258 patients with active RA. Using the Radiogrammetry Kit program, we also performed semiautomated measurements of joint space width(JSW)atthesecondthroughthefifthmetacarpophalangeal (MCP) joints in these patients.Results. All correlations between the different parameters of both techniques (BMD and the MCI as measured by DXR and MCP JSW as measured by the Radiogrammetry Kit) were significant (0.36 < R < 0.63; P < 0.01). As expected, a significant negative association was shown between the different MCP JSW results and the results of all scoring methods (؊0.67 < R < ؊0.29). The BMD and the MCI measured by DXR both decreased significantly between Steinbrocker stage I and stage IV (by 32.7% and 36.6%, respectively; both P < 0.01). Reductions in the overall (mean) MCP JSW varied from 35.3% (Larsen score) to 52.9% (Steinbrocker stage). Over a period of 6 years, we observed relative decreases in BMD and the MCI as measured by DXR (32.1% and 33.3%, respectively), as well as in the overall (mean) MCP JSW (23.5%), and these were pronounced in early RA (duration <1 year). In addition, excellent reproducibility of DXR and Radiogrammetry Kit parameters was verified (coefficients of variation <1%).Conclusion. DXR with the integrated Radiogrammetry Kit program could be a promising, widely available diagnostic tool for supplementing the different RA scoring methods with quantitative data, thus allowing an earlier and improved diagnosis of RA and more precision in determining disease progression.

This case report of a 61-year-old woman suffering from Gorham-Stout syndrome shows osteolyses of the left pelvis, proximal femur and lumbar spine. The therapeutic regime has included two courses of percutaneous radiotherapy and also continuous application of bisphosphonates over 17 years. Despite this antiresorptive therapy, elevated urinary excretion of desoxypyridinoline has indicated the persistence of increased bone destruction. The radiological progression following bisphosphonate treatment was only moderate. However, physical disability is reduced, but without soaring handicaps suggesting that long-term bisphophonate therapy is a therapeutical option for this rare syndrome.

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