Three hundred and fifty-two patients with alcoholic hepatitis were evaluated for protein-calorie malnutrition (PCM). In order to facilitate data analysis of nutritional status, a PCM score was calculated for each patient using eight nutritional parameters. The PCM score correlated significantly with mortality, clinical severity of the liver disease, and biochemical liver dysfunction. When 30 day changes in the PCM scores were compared with 30 day caloric intake (expressed as percent basal energy expenditure (BEE], a marginally significant correlation was observed (p = 0.05). However, those patients who showed improvement in their PCM score over 30 days of hospitalization also improved their 6-mo and 1-yr survival. These data indicate that nutrition, as determined by the PCM score, has prognostic significance. Additional studies are needed to establish the beneficial role for vigorous protein-calorie nutritional therapy in the management of alcoholic hepatitis.

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1. Stimulation of the whole hypoglossal (XIIth) nerve or its medial or lateral branch in the rat produced two major movements of the tongue as measured with a single force transducer attached to the tip of the tongue. Stimulation of the whole XIIth nerve or the lateral branch produced a retrusion of the tongue, whereas stimulation of the medial branch produced a protrusion. 2. The average retrusive twitch tension evoked by stimulation of the XIIth nerve (11.25 g) or the lateral branch (12.02 g) was significantly greater (P < or = 0.0001) than the protrusive twitch tension (1.05 g) elicited by medial branch stimulation. The tetanic tension produced by lateral branch stimulation (36.82 g) was significantly greater (P < or = 0.007) than the whole nerve tetanic tension (28.23 g). The greater tension elicited by stimulation of the lateral branch of the nerve when compared with the tension elicited by stimulation of the whole XIIth nerve was probably due to the absence of protrusive axons in the lateral branch of the nerve. Stimulation of the whole XIIth nerve activates axons innervating both protrusive and retrusive muscles, resulting in a weaker net retrusive force. 3. The contraction time of the tongue in response to medial branch stimulation (10.94 ms) was significantly faster than when the whole XIIth nerve (15.68 ms, P < or = 0.007) or lateral branch (13.36 ms, P < or = 0.05) was stimulated. The twitch contraction time of the tongue in response to whole XIIth nerve or lateral branch stimulation was not significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)

A cooperative study was conducted to determine the efficacy of 30 days of treatment with either a glucocorticosteroid (prednisolone) or an anabolic steroid (oxandrolone) in moderate or severe alcoholic hepatitis. One hundred thirty-two patients with moderate disease and 131 with severe disease were randomly assigned to one of three treatments: prednisolone, oxandrolone, or placebo. During the 30 days, mortality in the groups receiving steroid therapy was not significantly different from mortality in the placebo group. Thirteen per cent of the moderately ill patients and 29 per cent of the severely ill patients died. Although neither steroid improved short-term survival, oxandrolone therapy was associated with a beneficial effect on long-term survival. This was especially true in patients with moderate disease: among those who survived for one or two months after the start of treatment the conditional six-month death rate was 3.5 per cent after oxandrolone and 19 to 20 per cent after placebo (P = 0.02). No consistent long-term effect was associated with prednisolone therapy.

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