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The association of high-amplitude echoes returned from the liver in diffuse fatty infiltration has now become well recognized. We report our experience on the accuracy with which ultrasound will detect a fatty liver. A review was made of the liver ultrasound images in patients known to have either histologically normal livers or livers with fatty infiltration. Only two of 40 patients with normal liver biopsies had a brightly reflective echo pattern, but 12 of 20 patients with fatty infiltration showed this pattern. Of the patients with histologically moderate or severe fatty infiltration, nine out of ten had a brightly reflective echo pattern.

The assessment of malnutrition by simple methods was studied in 120 patients undergoing elective major abdominal surgery to determine which index was of the most value in predicting postoperative complications. Weight for height and weight loss were of little significant value; serum albumin less than 35 g/l was more significant (p less than 0.05) but predicted only a quarter of those patients who developed serious complications. Measurements of muscle stores by anthropometry (arm and forearm muscle circumference) predicted nearly half the patients (p less than 0.01). By far the most useful index was hand-grip dynamometry, which predicted 90% of those who developed complications (p less than 0.001). The incidence of serious complications was 6 times greater in those patients with a low grip strength. Hand-grip dynamometry appears to be a useful screening test of patients at risk, and a valuable additional test for nutritional assessment.

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