The 35 patients we studied were 42 i 12 (S.D.) yr of age (range = 17 to 62 yr) and 14 were men. The 21 studied 3 mo

Patients with end-stage liver disease have low bone-turnover osteoporosis, and there is often further bone loss of 20% to 30% after orthotopic liver transplantation (OLT). Bone recovery after OLT has been reported, but data are limited. We undertook studies to determine whether bone recovery continues in the long term. Twenty-eight adult patients alive at least 5 years after OLT were studied (14 men, 14 women). Bone mineral density (BMD), serum parathyroid hormone (PTH), osteocalcin, and vitamin D levels were measured pretransplantation, at 3 months, 12 months, a mean of 46 months, and a mean of 85 months (range, 63 to 117 months) after transplantation. When BMD is expressed as a z score, the results were as follows: ؋0.82 ؎ 0.22 pre-OLT; ؊2.04 ؎ 0.27 at 3 months; ؊1.68 ؎ 0.24 at 12 months; ؊1.23 ؎ 0.24 at a mean of 46 months; and ؊1.0 ؎ 0.26 at a mean of 85 months after OLT. The results at 46 and 85 months were significantly greater than the measurement at 3 months after OLT (P F .05). Furthermore, mean BMD (expressed as a z score) returns to the pre-OLT level at a mean of 85 months. At final follow-up, 9 of 28 patients had elevated PTH levels, and 14 of 27 patients had elevated osteocalcin levels. Five patients had spontaneous fractures in the first 12 months after transplantation, and 5 more patients had fractures by final follow-up. Even at 7 years after OLT, there was a significant increase in BMD (expressed as a z score) compared with 3 months after transplantation. Elevation of serum PTH and osteocalcin levels in some patients suggests continuing bone remodeling.

SUMMARY Traumatic rupture of the aorta is a lesion requiring prompt diagnosis and surgical treatment for optimum patient survival. Plain chest x‐rays, erect or supine, should be regarded as suggesting this diagnosis whenever a mediastinal abnormality is seen in the patient with severe chest trauma, and aortography should be performed. Aortography may be safely performed from the femoral artery if a cautious technique is used. Aortography produces unequivocal evidence of aortic rupture with precise anatomical localization.

Summary Three cases of pseudomembranous colitis are described and the barium enema findings reviewed. That this disease can sometimes occur as a relatively mild, self‐limiting condition is stressed

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