Nine patients with acute lymphocytic leukemia in remission, aged 12-35 years, undergoing allogeneic bone marrow transplantation (BMT) were studied for changes in body fluid balance and body composition. Body composition and fluids were assessed the first 4 weeks following BMT, using isotope dilution and anthropometry. Oral and parenteral nutrient intakes were recorded daily. Tracer dilution techniques were used to assess body fluid volumes and estimate body cell, lean body, and body fat masses. Body cell mass was lost (mean -1.62 kg, P less than 0.05) without significant changes in body fat or lean body masses. There was an expansion of the extracellular fluid compartment (mean +0.8 l, P less than 0.05) and a loss in the intracellular fluid compartment (mean -1.3 l, P less than 0.05) with little change in total body water volume. Changes in body weight correlated poorly with body cell mass or fluid volume changes. Change in arm muscle area correlated well with changes in body cell mass (r = 0.61, P less than 0.05) and lean body mass (r = 0.68, P less than 0.05), while that of arm fat area did not reflect its isotope dilution-derived counterpart. Instead, the change in arm fat area was related to shifts in fluid compartments. Prealbumin decreased significantly (mean -9.3 mg/dl, P less than 0.05), while albumin decreased slightly (mean -0.1 mg/dl), and both were related to changes in body cell mass. Nitrogen balance was negative throughout the study and the overall mean was related to the change in body cell mass (r = 0.60, P less than 0.05). Calorie and protein intakes were not associated with the changes in body composition, implying other causal factors.

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Growing awareness of Lyme disease, caused by the tickborne spirochete Borrelia burgdorferi has led to a marked increase in laboratory procedures to help in its diagnosis. Despite the frequent ordering of serologic tests specific for Lyme disease, there remains confusion in the accurate interpretation of these tests. Because of the important cutaneous manifestations of B burgdorferi infection, dermatologists should understand the role of the laboratory in Borrelia-related conditions. This article reviews laboratory techniques available for the diagnosis of Lyme disease. The role of histologic findings and culture, the sensitivity, specificity, and reproducibility of commonly used serologic tests, the effects of disease duration and treatment on serologic results, and the future of laboratory diagnosis are described.