Arthur S. Littell

Pulmonary Function in Paralytic and Non-Paralytic Scoliosis before and after Treatment

The results of pulmonary-function studies done on sixty-three patients with paralytic and non-paralytic scoliosis are presented. The results confirm the concept that angular deformities of the spine cause impairment of pulmonary function. The results also demonstrate that the application of the preoperative corrective device further reduces pulmonary function except when the halo apparatus is used as the corrective device. There is no significant improvement of pulmonary function following spine fusion. The importance of blood-gas and diffusion-capacity studies is discussed.

Change in Relationship of Blood Volume to Weight in Congestive Heart Failure

Blood volume has been estimated in a small group of nonedematous hospitalized patients and in cardiac patients in severe congestive failure by both Cr51-labeled red cells and iodinated (I131) human serum albumin. In the analysis of the data attention is directed to a fallacy inherent in the usual ratio method of relating blood volume to weight. An alternative method of analysis is proposed that not only yields greater accuracy, but makes the analysis more sensitive. The authors present their interpretation of the effects of tissue wasting and accumulation of edema fluid on the changes in the relationship between blood volume and weight in congestive heart failure. Analyzing other data from the literature by this method the authors have demonstrated a relationship between the amount of edema fluid and the increase in blood volume in congestive failure.

An evaluation of the variability in measurement of some body composition parameters.

Summary The variability in observation of some parameters of gross body composition was assessed by paired observations one week apart in 26 chronically ill subjects. The results of this study permit statistical evaluation of the significance of changes in these parameters observed in other subjects, using the same experimental techniques.

BODY COMPOSITION OF “WELL NOURISHED” COMPARED TO “POORLY NOURISHED” CHRONICALLY ILL PERSONS*

In order to assess the variable of nutritional state in relation to the presence of or progress of chronic illness, nutritional state must be defined objectively. Objective definition implies measurement that is valid, reliable, reproducible, and subject to estimations of intrinsic technical or observer variation. Furthermore, the definition must be related to the problem at hand. Nutritional state may be considered “good or “poor” or relative to these extremes. If the frame of reference is a chronic illness, “good nutritional state would prevent, cure, or delay the progress of disease; the reverse would be true of a Measurement of nutritional state to meet the criteria for objective assessment mentioned above would depend on physical or biochemical techniques. Validation of these techniques depends on an independent definition of nutritional state. In addition, the independent definition should permit a dichotomy of nutritional state into ”good” and “poor” with all questionable decisions as to nutritional state discarded. If the measures selected discriminate between good and poor they may be useful in those instances where the criteria for the independent judgment cannot be applied with accuracy. This is particularly true when a decision must be made between two individuals as to which is better nutritionally than the other. In the study of the role of nutrition in chronic illness it is not always enough to establish that means for a particular value are different in two groups of people. Frequently, one must study small numbers of patients, pairs of patients, or two points in time in the same patient. In these instances placement on a scale of relative goodness of nutritional status is desirable. We have investigated the possibilities of using gross body composition as a measure of nutritional state that would satisfy the foregoing considerations for an objetcive measure. For an independent evaluation of nutritional state we selected “clinical” judgment. This was done in the full knowledge that this was a precarious choice on which to classify individuals. For one thing, it is almost impossible to define without bringing into the judgment the very factors that we would be assessing by body composition studies. However, in the absence of a good way of defining nutritional state from the standpoint of good or poor we felt we could achieve the dichotomy by selecting patients who, by clinical judgment, were in much poorer nutritional state than were those patients with the same disease, and within five years of the same age, selected as good. Poor nutri-