[Myasthenia and pernicious anemia or Biermer's (author's transl)]

The association of myasthenia and Biermer's anemia is very rarely reported. In a series of 138 cases of myasthenia, this association was found in only one patient, in whom the anemia developed 19 years after the discovery of a calcified thymoma and 13 years after the appearance of the first signs of myasthenia. This led the authors to conduct a prospective study for the presence of intrinsic antifactor antibodies. A total of 81 patients (20 men and 61 women) with myasthenia were studied. The myasthenia had appeared after 35 years of age in 40 patients and 19 had a thymoma. The results of the study for the antibodies was positive in 3 women, as was the test of inhibition of leucocyte migration, but none of them had anemia, vitamin B12 malabsorption, achlorhydria, or gastric atrophy. The discovery of these immunological disorders raises the problem of their significance ; two hypotheses can be discussed : pre-Biermer state or immunological disturbance without pathogenetic significance. The problem can probably only be resolved by studying these antibody levels in a very much larger number of patients with myasthenia.

Pernicious anaemia and granulomatous skin lesions in a case of common variable hypogammaglobulinaemia

A 45-year-old woman is reported with a history of recurrent bacterial infections since childhood; at the age of 37 years she developed recurrent ulcerated lesions around her mouth, in the groins and buttocks, which histologically contained small, non-caseating granulomas. A year latter when being treated for empyema, she was found to have common variable hypogammaglobulinaemia. Three years after this she developed a megaloblastic anaemia of vitamin B12-deficiency type.

[Anaemia and microcytosis during thyrotoxicosis. Physiopathological discussion. 36 cases (author's transl)]

Study of 36 cases of thyrotoxicosis demonstrated the prevalence of anaemia (17 cases) and of microcytosis (26 cases). In patients with a microcytosis, serum iron was measured in 9, being found to be low in 5 of them, whilst amongst twelve 10 had anti-thyroid antibodies and anti-gastric antibodies. Atrophic gastritis was seen in the 5 patients who underwent endoscopy. Four biopsies revealed 3 cases of atrophic gastritis and one of simple gastritis. The types of anaemia seen and their mechanisms are discussed: microcytic anaemia related to disturbed iron metabolism or to its impaired intestinal absorption; normocytic anaemia; macrocytic anaemia possibly preceding pernicious anaemia. It would seem to be possible to distinguish two pathogenic categories: thyrotoxicosis reversible changes in iron metabolism, and atrophic gastritis associated with hyperthyroidis in an "auto-immune context" and which has led to the concept of "thyro-gastric" disease.

Pernicious anemia caused by Crohn's disease of the stomach

A patient with granulomatous gastritis is described. Two years after the presentation of his gastric disease he developed pernicious anemia. Lack of intrinsic factor production secondary to Crohn's disease of the stomach is felt to be the cause of his Vitamin B12 malabsorption.

Gastrointestinal complications of immunodeficiency syndromes

Patients with B cell deficiency have a high incidence of prolonged Giardia lamblia infection of the gastrointestinal tract that causes symptoms of malabsorption with villus flattening. The changes are reversible with therapy directed against Giardia. There is a high incidence of pernicious anaemia in patients with agammaglobulinaemia. Those with abnormal B lymphocytes tend to develop lymphoid nodular hyperplasia. Gastrointestinal disease is rare in boys with X-linked agammaglobulinaemia when compared with adults with the 'acquired' or common variable form of the disease. T cell deficiency results in intractable diarrhoea and monilial infection of the gastrointestinal tract.

Anemia--a common but never a normal concomitant of aging

Diagnosis is often overlooked because symptoms develop slowly and insidiously and many patients don't complain about them. Then too, the giddiness, apathy, confusion, clumsiness, and similar problems may be considered simply signs of "old age." Iron deficiency anemia is the most common type in old people. It's usually due to gastrointestinal bleeding, but there may be a second, less obvious cause. The classic picture of low serum iron, high total iron-binding capacity, and low iron-binding saturation is sometimes distorted. Usually, many studies are needed to confirm the suspicion of a vitamin B12 or folic acid deficiency. A raised mean corpuscular volume in itself signals the need for further investigation. In patients with macrocytosis, the bone marrow must be examined. Tests for intestinal malabsorption must be considered too. Repeated blood tests are essential in patients being treated for any type of anemia. Iron deficiency may hide evidence of folate or B12 deficiency. And iron therapy may lessen bleeding from colonic cancer, delaying diagnosis until it's too late to operate.

Total gastrectomy: twenty years' experience

The management and treatment of patients with gastric cancer is all encompassing. It includes preoperative care, operative resection postoperative sympathetic encouragement with therapeutic and nutritional guidance. This has been the experience with 62 human beings afflicted with malignant disease of the stomach. The end result has been that approximately 50% of these patients survived five years or more. This is a comparative favorable percentage when considering cancer elsewhere in the gastrointestinal tract. What is more enlightening is that the patients were comfortable and able to enjoy a pleasant personal diet during the five or more years following surgery. This salubrious state is attributed to the preservation of a small segment of stomach which enabled the intrinsic factor in the gastric mucosa to participate in and contribute to the normal hemopoietic physiological process.

Screening for hypothyroidism in elderly inpatients

Routine biochemical screening for hypothyroidism in 2000 geriatric inpatients proved valuable and practicable and yielded 46 cases (2.3%). A non-specific clinical picture was particularly common, with less than a third of the cases showing "typical" signs and symptoms. Psychiatric manifestations, especially depression, were important and frequent and responded well to thyroxine. There was a preponderance of female cases of hypothyroidism and a strong association with other autoimmune diseases, notably pernicious anaemia and rheumatoid arthritis.