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A letter to the editor is presented in response to the article about a case of hyperammonaemic encephalopathy in 66-year-old man with plasma cell leukemia that was published previously.

Background In patients with suspected cardiac sarcoidosis, late gadolinium enhancement on cardiovascular magnetic resonance imaging and/or 18 F-fluorodeoxyglucose uptake on positron emission tomography are often used to reach a clinical diagnosis of cardiac sarcoidosis. On the basis of data from the imaging literature of clinical cardiac sarcoidosis, no specific features of myocardial involvement are regarded as pathognomonic for cardiac sarcoidosis. Thus, a diagnosis of cardiac sarcoidosis is challenging to make. There has been no systematic analysis of histologically diagnosed cardiac sarcoidosis for patterns of myocardial involvement. We hypothesized that certain patterns of myocardial involvement are more frequent in histologically diagnosed cardiac sarcoidosis. Methods and Results We performed a systematic review and meta-analysis of gross pathological images from the published literature of patients with histologically diagnosed cardiac sarcoidosis who underwent autopsy or cardiac transplantation. Thirty-three eligible articles provided images of 49 unique hearts. Analysis of these hearts revealed certain features of myocardial involvement in >90% of cases: left ventricular (LV) subepicardial, LV multifocal, septal, and right ventricular free wall involvement. In contrast, other patterns were seen in 0% to 6% of cases: absence of gross LV myocardial involvement, isolated LV midmyocardial involvement, isolated LV subendocardial involvement, isolated LV transmural involvement, absence of septal involvement, or isolated involvement of only one LV level. Conclusions In this systematic review and meta-analysis of histologically diagnosed cardiac sarcoidosis, we identified certain features of myocardial involvement that occurred frequently and others that occurred rarely or never. These patterns could aid the interpretation of cardiovascular magnetic resonance imaging and positron emission tomography imaging and improve the diagnosis and the prognostication of patients with suspected cardiac sarcoidosis.

Background: Overweight, obestity, and lack of fitness in America is reported to be increasing at an accelerated pace. This national trend has serious health and economic ramifications not only for the general population but also directly for industry. Obesity in the workplace has resulted in increased expenses to industry: directly through increased medical costs and indirectly through decreased productivity. The intent of this study is to define changes in fitness and body fat percentage in a working population in an isogeographical area over the past decade., Methods: Data accumulated during a routine post-offer testing program were divided into two groups composed of new industry hires tested from 1990 to 1992 and from 2000 to 2002. Body fat was measured with a standard skinfold. The body fat percentage and body mass index (BMI) from year 1990 were compared to those from year 2000. Fitness was assessed through an individual's ability to perform a timed maximum number of sit-ups and squats., Results: There was no significant difference in the BMI between the year 1990 group and the year 2000 group (P = 0.132 for females and P = 0.110 for males). There was a significant increase in body fat percentage from the 1990 group to the 2000 group (P = 0.000 for females and P = 0.000 for males). A significant decrease in fitness was observed for both males and females during the 10-year interval of the study., Conclusions: Percent body fat appears to be a better indicator than BMI for utilization in industry for evaluation of obesity in the workplace. The differences in significance levels between BMI and percent body fat suggest that a decrease in leisure-time fitness activities could potentially contribute to the trend toward obesity. This study demonstrates that strength and/or fitness are important indicators that industry should monitor in order to improve the health and fitness of the workforce. Direct measurement of percent body fat and fitness indices are a more precise means than BMI for monitoring the workforce especially if employers are going to reward healthy behavior., (Copyright 2006 Wiley-Liss, Inc.)