Emaciated Patients Research Articles

Limberg Flap for Lateral Midface Reconstruction.

Several local skin flaps and tissue rearrangement techniques have been described in the literature, including the rhomboid flap. The Limberg flap is one of the most versatile local flaps that can be used for reconstruction of a wide range of skin defects in different parts of the body. The purpose of this study is to demonstrate the safety and applicability of the Limberg flap for reconstruction of skin facial defects, particularly after cutaneous tumor resection. The following article presents a retrospective case series of 8 patients in whom the Limberg flap was used to reconstruct skin defects resulting from malignant tumor resections in the lateral part of the face. No restrictions were collected regarding etiology, location, size, age, sex, or any other patient factors. The recruited patients were treated in the Maxillofacial Surgery Unit of Floraspe Renzetti Hospital of Lanciano and the study was conducted in collaboration with Sapienza University of Rome, from April 2023 to April 2024. All the flaps settled with no complications and all the patients were FOD (free of disease) 6 months after surgery. So, in accordance with the literature, the Limberg flap turns out to be a rapid and reliable option that could be easily applied for small (size around 1-2cm) and medium-sized (size around 2-4cm) cutaneous defects of the face even for the oldest and/or emaciated patients.

Epidemiological, therapeutic, cytogenetic, and molecular profile of chronic myeloid leukemia at the national reference university hospital of N’Djamena from 2010-2020, Chad

The aim is to determine the epidemiological and cytogenetic profile (Philadelphia chromosome: Ph1) and the bcr-abl gene in patients with chronic myeloid leukemia (CML) and to assess the therapeutic response of patients to hydroxy-urea and Imatinib treatment. From January 1, 2010 to December 30, 2020, an observational study for diagnostic and analytical purposes was carried out in 54 cases of CML at the National Reference University Hospital (CHU-RN) of N’Djamena. All selected patients presented with splenomegaly on physical examination. Significant differences were observed between the proportion of housewives (31.48%) and civil servants (3.70%), emaciated patients (27.84%) and those with fever (3.70%) with the probabilities of 0.001 and 0.001 respectively. Hyperleukocytosis ranged from 100,000-149,000 GB / mm3 (42.30%) and the platelet count ranged from 20,000 / mm3 to 611,000 / mm3. Polymorphic and massive myeloma was 30-80% of cases, a medullary karyotype with 33.33% Ph1 + chromosome and 66.66% Ph1-, 33.33% bcr-abl transcript and 33.33% transcribed b3 a2 respectively. The treatment regimens were: Hydroxy-Urea (HU) + prednisolone (60%), and Imatinib + prednisolone (40%). Partial hematological remission was obtained in 40% of cases. CML is a condition that occurs at all ages and especially in men in our region. The continuation of this study at the national level will allow the public authorities to achieve national prevalence and to organize effective prevention and early management.

Skeletal Muscle Damage in COVID-19: A Call for Action.

Both laboratory investigations and body composition quantification measures (e.g., computed tomography, CT) portray muscle loss in symptomatic Coronavirus disease 2019 (COVID-19) patients. Muscle loss is associated with a poor prognosis of the disease. The exact mechanism of muscle damage in COVID-19 patients, as well as the long-term consequences of muscle injury in disease survivors, are unclear. The current review briefly summarizes the literature for mechanisms, assessment measures, and interventions relevant to skeletal muscle insult in COVID-19 patients. Muscle injury is likely to be attributed to the cytokine storm, disease severity, malnutrition, prolonged physical inactivity during intensive care unit (ICU) stays, mechanical ventilation, and myotoxic drugs (e.g., dexamethasone). It has been assessed by imaging and non-imaging techniques (e.g., CT and electromyography), physical performance tests (e.g., six-minute walk test), anthropometric measures (e.g., calf circumference), and biomarkers of muscle dystrophy (e.g., creatine kinase). Interventions directed toward minimizing muscle loss among COVID-19 patients are lacking. However, limited evidence shows that respiratory rehabilitation improves respiratory function, muscle strength, quality of life, and anxiety symptoms in recovering older COVID-19 patients. Neuromuscular electrical stimulation may restore muscle condition in ICU-admitted patients, albeit empirical evidence is needed. Given the contribution of malnutrition to disease severity and muscle damage, providing proper nutritional management for emaciated patients may be one of the key issues to achieve a better prognosis and prevent the after-effects of the disease. Considerable attention to longer-term consequences of muscle injury in recovering COVID-19 patients is necessary.

Body weight and bone/calcium metabolism. Bone and calcium metabolism in anorexia nervosa.

Osteoporosis is one of chief complications of anorexia nervosa. Their calcium intake decreases and 84%are lack of vitamin D. The abnormal bone metabolism in severely emaciated patients with anorexia nervosa involves both a reduction in bone formation and an increase in bone resorption. The annual change in lumbar bone mineral density(BMD)is significantly correlated with body mass index(BMI)at the entry. The critical BMI for a positive increase in BMD was 16.4±0.3 kg/m2. Since 30%of patients are lack of vitamin K, their bone quality deteriorates. The risk factors of a decrease in lumbar vertebrae BMD is a duration of emaciation when both serum levels of insulin-like growth factor-Ⅰ as a potent osteogenic factor and estradiol as a powerful bone resorption inhibitor decrease. Therefore, the prevention and the treatment are weight gain. However, the patient does not accept weight gain easily. Active form vitamin D3 of 0.5μg/day or 30-45 mg/day of vitamin K2 preparation prevents the further decrease in bone mineral density. Eldecalcitol of 0.5μg/day shows about 5%increase in lumbar vertebrae BMD in first year. Bisphosphonate and a RANK ligand inhibitors, denosumab should not be used for young patients and women in hope of the pregnancy.

Facial Soft Tissue Thickness of Midline in an Iranian Sample: MRI Study.

Background and Aim:To identify human skeletal remains, different methods can be used and using these techniques, important data can be obtained. However, facial reconstruction is the last method to indentify unknown human faces which requires knowledge about facial soft tissue thickness in the different positions of the face. The present study determined the facial soft tissue thickness in the different landmark points on the MRI images of patients referred to Radiology Department of Shahid Madani Hospital.Materials and Methods:In this descriptive cross-sectional trial, MRI images of 179 patients (61 males, 118 females) in the age range of 18-76 years old who did not show any pathologic lesions, were selected. The measurements of the facial soft tissue were done on 12 landmark points on the midline area by two radiologist observers using specific software on the images. The differences in the soft tissue thickness in these landmark points were statistically analyzed by Mann-Whitney U (in term of gender) and Kruskal-Wallis tests (in terms of Body Mass Index [BMI] and age groups). P value less than 0.05 was considered statistically significant. The data were compared with the results of other studies.Results:The results obtained in the present study were higher than Turkish and American studies in most of the landmark points. Facial soft tissue thickness in most of the landmarks was more in males than females. In some of the landmarks, significant differences were found between emaciated, normal and overweight patients while in most cases, soft tissue thickness increased with the increased BMI. In some cases, significant differences were noted between soft tissue thickness values among the different age groups, in which the thickness increased or thinned with the increased age.Statistical Analysis:There were statistically significant associations between the presence and surface area of Haller cells and the occurrence of ipsilateral maxillary sinusitis. Neither the angulation of the uncinate process nor the size of the maxillary sinus ostium significantly correlates with the formation of maxillary sinusitis.Conclusion:The data achieved in the present study can be used for the facial reconstruction purposes in the Iranian population; however, the slight differences existing between the studied population and other subgroup races must be considered for accurate reconstructions.

Ocular Myaisis– A Case Report

A case of destructive ocular myiasis in the right eye of an healthy and non-compromised host having poor personal hygiene. Mechanical removal and good local hygiene helped to heal the wound. The larvae isolated were found to be that of Chrysomyia bezziana (screwworm fly). Infestation of human eyes with larvae of flies (myiasis) has been reported. Serious consequences of destructive myiasis are seen in emaciated and diseased patients. Only one report of total destruction of the globe by maggots of Chrysomyia bezziana exists in the literature. Mechanical removal of maggots is an important step in the management of patients with myiasis.

Higher incidence of injection site reactions after subcutaneous bortezomib administration on the thigh compared with the abdomen

Subcutaneous (sc) rather than intravenous administration of bortezomib (Bor) is becoming more common for treating multiple myeloma (MM) because scBor results in lower incidence and severity of peripheral neuropathy and has equivalent efficacy. Bor is an irritant cytotoxic agent when it leaks out; therefore, it is recommended that injections of scBor should be rotated among eight different sites on the abdomen and thigh. However, detailed information about injection site reaction (ISR) has not been sufficiently documented. We retrospectively analyzed the incidence and severity of ISR following scBor administration in 15 Japanese patients with MM. Grade 1 ISR occurred following 40 of 158 (25.3%) scBor injections in ten patients, whereas grade 2 ISRs occurred following seven injections (4.4%) in five patients. Five patients did not develop ISR. Of note, grade 2 ISR was documented in 6 of 65 (9.2%) thigh injections but only in 1 of 93 (1.1%) abdominal injections. These data show that grade 2 ISRs were more common in the thigh compared with the abdomen possibly because the thigh contains lesser adipose tissue than the abdomen. Grade 2 ISRs resolved without any sequela within a median of 7d. scBor administration on the abdomen instead of the thigh should be considered, especially for emaciated patients, because ISR rapidly resolves within the interval before the next injection even if it occurs.

Nephrology in Brief

The bone morphogenic protein (BMP) antagonist gremlin was highly expressed in the cellular and fibrocellular crescents of 30 renal biopsies of patients with pauciimmune glomerulonephritis—as well as in renal tubular and infiltrating interstitial cells. It correlated with tubulointerstitial fibrosis and co-localized with transforming growth factor beta (TGF-β), suggesting that it may be important in mediating some of its pathological effects (Nephrol Dial Transpl 22: 1882). Soluble F11 receptor (F11R) is elevated in dialysis patients and may be yet another marker of increased cardiovascular risk. It is a cell adhesion molecule expressed on the membrane surface of platelets and related to the murine protein present in the tight junctions of the vascular endothelium. In activated platelets F11R becomes phosphorylated and causes cell adhesion and aggregation—the initial step of thrombus formation in the pathogenesis of atherosclerotic plaques (J Invest Med 55:115). In order to study the mechanism of renal injury from light chains, cell cultures of human proximal cells were incubated with light chains derived from the urine of patients with multiple myeloma. This resulted in the cells producing hydrogen peroxide and monocyte chemo-attractant protein-1, both inherently nephrotoxic (J Am Soc Nephrol 18:1239). The use of estimated glomerular filtration rate (GFR) derived from the serum creatinine concentration is fraught with pitfalls. It tends to undererestimate renal function in persons with no known kidney disease and overestimate it in emaciated patients with low muscle mass and reduced creatinine production. Also problematic is its use in acute renal failure, where the change in serum creatinine is more important (BMJ 334:1198, Nephrol Dial Transplant 22:2391). Subjects in the Framingham study who had both microalbuminuria and reduced eGFR had worse cardiovascular outcomes than those with only one of these abnormalities (Arch Int Med 167:1386 2007). A study of type II diabetics with nephropathy found that simvastatin, unlike cholestyramine, appears to stabilize GFR, possibly by increasing messenger RNA expression of slit diaphragm associated proteins and reducing the albumin excretion rate (Kidney Int 70:177–186). The administration of iodine containing contrast media to a hemodialysis patient resulted in so-called iodine gout, an acute and dramatic swelling of the thyroid and salivary glands. This rare idiosyncratic complication may be related to toxic accumulation of iodide in the salivary gland ducts. The patient improved dramatically within 48 h of high-dose prednisolone therapy (Nephrol Dial Transpl 22: 1250)

Bioactive Insulin-Like Growth Factor (IGF) I and IGF-Binding Protein-1 in Anorexia Nervosa

Regulation of IGF-I activity appears crucial in anorexia nervosa (AN) during adaptation to chronic starvation as well as during the regenerative processes on nutritional restoration. The objective of this study was to examine the relationship between IGF-I bioactivity and IGF-binding capacity as expressed as formation of the binary complex of IGF-binding protein-1 (IGFBP-1) and IGF-I in patients with AN at different stages and with different subtypes of the disease. This was a longitudinal study. The study took place at a clinical research center at a university hospital. We studied a total of 45 women with AN and 24 age-comparable healthy controls. IGF-I bioactivity was determined using an IGF-I receptor activation assay, and IGF-I/IGFBP-1 complex formation was determined by an assay that allows direct determination of the binary complex. IGF-I bioactivity was significantly decreased in serum from patients with AN. We found significant correlations between total, ultrafiltered free, and bioactive IGF-I. Despite increased IGFBP-1 concentrations, levels of IGF-I/IGFBP-1 binary complex were not significantly increased in AN. Oral contraceptives were associated with increased levels of IGF-I, IGFBP-1, and binary complex formation. Ghrelin levels were only significantly raised in those patients who had lost more than 5% of the body weight during the last 4 wk, whereas ghrelin levels in weight-stable as well as in weight-gaining patients did not significantly differ from the controls. Total IGF-I level is a suitable marker of IGF-I bioactivity in emaciated patients with AN irrespective of the clinical subtype and acute nutritional state.

Modified surgical procedures in intestinal tuberculosis

The results of modified surgical procedures in intestinal tuberculosis in 79 patients are presented. Special emphasis is laid on the role of limited ileocaecal resection and ileoplasty. These procedures are safe, quick and easy with preservation of functional portions of the bowel. They are of immense value in emergencies in chronically ill and emaciated patients.

Change in signal intensity on MRI of fat in the head of markedly emaciated patients.

The amount of fat in various parts of the body decreases in emaciated patients, but responds differently to disease processes. The order of disappearance of fat in various parts of the head has rarely been studied with MRI. We imaged ten patients with anorexia nervosa and one cachectic patient with a psychiatric disorder with a 1.5 T imager. Signal intensities of bone marrow of the skull, subcutaneous tissue, and orbits were assessed on T1- and T2-weighted images, and correlated with the body mass index (BMI) and haemoglobin concentration (Hb). On T1-weighted images, five patients (BMI 15.6-17.8 kg/m2, mean 16.6 kg/m2; Hb 10.1-14.2 g/dl, mean 13.8 g/dl) showed the normal pattern of fat. One (BMI 13.6 kg/m2, Hb 10.4 g/dl) lost the high signal of bone marrow, but high signal of subcutaneous tissue and the orbits was preserved. High signal from bone marrow and subcutaneous tissue disappeared in three patients (BMI 11.5-13.5 kg/m2, mean 12.5 kg/m2; Hb 7.9-9.7 g/dl, mean 8.7 g/dl), but orbital high signal was preserved. The remaining two patients (BMI 9.3 and 13.5 kg/m2, mean 11.5 kg/m2; Hb 7.6 and 8.9 g/dl, mean 8.3 g/dl) showed complete loss of high signal from fat in the head. The order of disappearance of fat (bone marrow, subcutaneous fat, then orbits) correlated with both BMI and Hb. Atrophy of bone marrow was demonstrated on T2-weighted images in five patients with BMI 13.5 kg/m2 or less, and Hb 9.7 g/dl or less.

Altered energy metabolism in anorexia nervosa.

Optimal nutritional rehabilitation of anorexia nervosa requires more information concerning actual energy and substrate requirements. To this end, indirect calorimetry was performed in female patients (n=34, age 20.9+/-1.2 yr, body mass index [BMI] 15.6+/-0.2 kg/m(2); mean+/-SEM) soon after commencement of refeeding and at the time of discharge from hospital (n=18, BMI 19.0+/-0.3 kg/m(2)). Healthy female controls (n=18, age 24.6+/-1.3 yr, BMI 21.6+/-0.6 kg/m(2)) were also tested. Resting energy expenditure (REE) and respiratory quotient (RQ) were measured in the fasting state, followed by diet-induced thermogenesis (DIT) and RQ over a 4 h period following a 100 g oral glucose load. Compared with post-refeeding patients and controls, pre-refeeding patients had a high basal RQ and a low REE, with a paradoxically higher DIT (13.2+/-0.9% of REE vs. 8.3+/-1.2% and 8.6+/-0.9% in post-refeeding patients and controls, respectively). RQ values in pre-refeeding patients exceeded unity following the glucose load, probably reflecting net lipogenesis, whereas in the post-refeeding patients, post-glucose RQ was similar to that of controls, suggesting premature curtailment of lipogenesis. These data demonstrate energy wasting in emaciated patients with anorexia nervosa. Biological repair processes could account for disproportionate energy loss early in refeeding and there may be some later impediment to full restoration of fat stores.

Food of the Gods: Cure for Humanity? A Cultural History of the Medicinal and Ritual Use of Chocolate

The medicinal use of cacao, or chocolate, both as a primary remedy and as a vehicle to deliver other medicines, originated in the New World and diffused to Europe in the mid 1500s. These practices originated among the Olmec, Maya and Mexica (Aztec). The word cacao is derived from Olmec and the subsequent Mayan languages (kakaw); the chocolate-related term cacahuatl is Nahuatl (Aztec language), derived from Olmec/Mayan etymology. Early colonial era documents included instructions for the medicinal use of cacao. The Badianus Codex (1552) noted the use of cacao flowers to treat fatigue, whereas the Florentine Codex (1590) offered a prescription of cacao beans, maize and the herb tlacoxochitl (Calliandra anomala) to alleviate fever and panting of breath and to treat the faint of heart. Subsequent 16th to early 20th century manuscripts produced in Europe and New Spain revealed >100 medicinal uses for cacao/chocolate. Three consistent roles can be identified: 1) to treat emaciated patients to gain weight; 2) to stimulate nervous systems of apathetic, exhausted or feeble patients; and 3) to improve digestion and elimination where cacao/chocolate countered the effects of stagnant or weak stomachs, stimulated kidneys and improved bowel function. Additional medical complaints treated with chocolate/cacao have included anemia, poor appetite, mental fatigue, poor breast milk production, consumption/tuberculosis, fever, gout, kidney stones, reduced longevity and poor sexual appetite/low virility. Chocolate paste was a medium used to administer drugs and to counter the taste of bitter pharmacological additives. In addition to cacao beans, preparations of cacao bark, oil (cacao butter), leaves and flowers have been used to treat burns, bowel dysfunction, cuts and skin irritations.

Heart risk associated with weight loss in anorexia nervosa and eating disorders: electrocardiographic changes during the early phase of refeeding

Refeeding syndromes with electrolyte aberrations, heart failure and arrhythmias may complicate the nutritional rehabilitation of emaciated patients with eating disorders. Therefore, electrocardiographic (ECG) changes and changes in serum electrolyte concentrations following refeeding were studied in 37 admissions of 32 teenage girls with eating disorders. On admission they were all on a weight‐losing course and weighed 37.0 ± 8.0 kg (mean ± SD) following a weight loss of 14.2 ± 7.2 kg. On ECG recordings there was a prolongation of the QT interval and an increased QT dispersion. Serum concentrations of sodium, potassium and magnesium were with few exceptions normal. Serum concentrations of creatinine were high in relation to the low body weight, indicating protein catabolism. The first 2 wk of refeeding resulted in a weight gain of 1.7 ± 0.2 kg without signs of refeeding syndromes or electrolyte aberrations. QT prolongation and dispersion normalized within the 3 d of refeeding.It is concluded that oral refeeding of patients with eating disorders and weight loss can be performed efficiently and without causing refeeding syndromes. QT pathology, a consequence of acute starvation and a risk factor for cardiac arrhythmias, normalizes within days. In view of the need to balance adequate refeeding and reduction of QT pathology against the risks of refeeding syndromes the start of refeeding of severely emaciated patients is best performed in a hospital setting where monitoring of ECG and serum electrolytes is possible.

Review article: recognition and treatment of eating disorders in primary and secondary care.

Eating disorders are serious illnesses affecting 1-2% of young women. Patients may present to any doctor, sometimes atypically (e.g. unexplained weight loss, food allergy, infertility, diarrhoea), delaying diagnosis and leading to needless investigation. The cardinal signs are weight loss, amenorrhoea, bingeing with vomiting and other compensatory behaviours, and disturbances in body image with an exaggeration of the importance of slimness. When other causes have been excluded, useful investigations are serum potassium, bone mineral density scanning and pelvic ultrasound. In emaciated patients multiple systems may fail with pancytopaenia, neuromyopathy and heart failure. Clinical assessment of muscle power is used to monitor physical risk. Treatment may involve individual, group or family sessions, using cognitive-behavioural, psychodynamic and family approaches. More severe or intractable illness is treated with day care, with in-patient care in a medical or specialist psychiatric unit reserved for the most severely ill patients. Antidepressants have a place in the treatment of bulimia nervosa unresponsive to psychological approaches, and when severe depressive symptoms develop. The children of people with eating disorders may have an increased risk of difficulties. Support for the patient and family, and effective liaison between professionals, are essential in the treatment of severe eating disorders.

Heart risk associated with weight loss in anorexia nervosa and eating disorders: electrocardiographic changes during the early phase of refeeding.

Refeeding syndromes with electrolyte aberrations, heart failure and arrhythmias may complicate the nutritional rehabilitation of emaciated patients with eating disorders. Therefore, electrocardiographic (ECG) changes and changes in serum electrolyte concentrations following refeeding were studied in 37 admissions of 32 teenage girls with eating disorders. On admission they were all on a weight-losing course and weighed 37.0+/-8.0 kg (mean +/- SD) following a weight loss of 14.2+/-7.2 kg. On ECG recordings there was a prolongation of the QT interval and an increased QT dispersion. Serum concentrations of sodium, potassium and magnesium were with few exceptions normal. Serum concentrations of creatinine were high in relation to the low body weight, indicating protein catabolism. The first 2 wk of refeeding resulted in a weight gain of 1.7+/-0.2 kg without signs of refeeding syndromes or electrolyte aberrations. QT prolongation and dispersion normalized within the 3 d of refeeding. It is concluded that oral refeeding of patients with eating disorders and weight loss can be performed efficiently and without causing refeeding syndromes. QT pathology, a consequence of acute starvation and a risk factor for cardiac arrhythmias, normalizes within days. In view of the need to balance adequate refeeding and reduction of QT pathology against the risks of refeeding syndromes the start of refeeding of severely emaciated patients is best performed in a hospital setting where monitoring of ECG and serum electrolytes is possible.

Sclerosing encapsulating peritonitis associated with continuous ambulatory peritoneal dialysis: Surgical management

Sclerosis of the peritoneum with encapsulation of the small intestine is one of the most serious complications of continuous ambulatory peritoneal dialysis (CAPD) and is associated with a high mortality rate. Its presence should be suspected in patients treated by CAPD who develop small bowel dysfunction with associated abdominal pain and progressive loss of ultrafiltration. In its severest form, it leads to complete high small intestinal obstruction and requirement for total parenteral nutrition. We report the successful surgical management of two young, severely emaciated patients who had this complication of CAPD. Each had entrapment of their bowel by a thick, fibrosed, and calcified membrane. Both were treated by surgically peeling the membrane away from the intestines.

Morphologic and Histochemical Evaluation of Muscle in Patients with Chronic Pulmonary Emphysema Manifesting Generalized Emaciation

Twelve severely emaciated patients with emphysema and 4 control patients with mild emaciation were studied. Arterial blood gas analysis, pulmonary function tests, and muscle biopsy were performed. According to the percentage of ideal body weight (%IBW), patients were divided into two groups of 6 patients each; one with %IBW values greater than 70.0 (group 1) and the other with %IBW values less than 70.0 (group 2), and 4 control patients with emphysema whose %IBW values were greater than 85.5. %FEV1.0, PaO2 and Hugh-Jones scores in group 2 patients were consistent with significantly greater deterioration as compared with those in group 1 patients and controls. In the muscle fibers of 11 patients and 4 controls, nicotinamide and adenosine dinucleotide tetrazolium reductase activity was studded with spots. Nemalin rods were detected in 3 specimens in group 2 and in 1 specimen each in both group 1 and controls. These changes probably result from chronic hypoxemia. Fiber type grouping accompanied by type II dominant fiber atrophy was demonstrated in 5 patients of group 2, whereas type II fiber atrophy was shown in 2 specimens from patients of group 1. Diameters of both types I and II fibers in group 2 were smaller than those in group 1 and controls. Significant correlations were observed between fiber diameters and %IBW, %FEV1.0 and %IBW, and PaO2 and %IBW. Neurogenic and disuse muscular atrophy due to both hypoxic axonal disorder and disuse is likely to be the cause of the emaciation, and a 'vicious circle' between muscular atrophy, respiratory function and hypoxemia probably exists in group 2. Since mild or moderate emaciation was observed in controls and group 1 in spite of the lack of fiber atrophy, involvement of fat and connective tissue should also be taken into consideration to determine the cause of emaciation.

Peculiar enlargement of the nasopharynx in patients with anorexia nervosa

We examined the nasopharynx and brain in 17 patients with anorexia nervosa by CT and compared the findings with those of 44 normal subjects and of 5 patients of the same age with marked emaciation caused by various psychiatric disorders. An enlarged nasopharyngeal space with a flattened posterior wall and enlarged lateral pharyngeal recesses were demonstrated in all patients with anorexia nervosa whose weight was lowest at the time of the CT examination, and these CT features regressed or became normal quickly after they had gained some weight. This characteristic enlargement of the nasopharynx and lateral pharyngeal recesses was observed neither in the markedly emaciated patients (2 with schizophrenia, 1 with major depression, 1 with stupor and the other with an extremely unbalanced diet) nor in 44 normal subjects without emaciation. These features were therefore thought to be characteristic and of diagnostic significance.

Pancreatic invasion of gastric carcinoma in emaciated patients: the value of combined analysis with CT and upper gastrointestinal series

Pancreatic invasion of gastric carcinoma in emaciated patients: the value of combined analysis with CT and upper gastrointestinal series