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Htut TW, Thein KZ, Oo TH. Pernicious anemia: Pathophysiology and diagnostic difficulties. J Evid Based Med 2021; 14:161-169. [PMID: 34015185 DOI: 10.1111/jebm.12435] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
Pernicious anemia (PA) is the most common cause of vitamin B12 (cobalamin) deficiency anemia in the world. It is an autoimmune disease, comprising of salient features of autoimmune chronic atrophic gastritis (CAG) and cobalamin deficiency (CD). Although the anemia was first described as pernicious, it may well be controlled with vitamin B12 replacement. The onset and progression of PA is often insidious. Alternatively, patients may have no anemic symptoms since they become acclimatized to the subtle nature of the disease. Oftentimes, there is a possibility that the underlying disease may be missed unless a full blood count (FBC) is investigated, leading to hindrance in the treatment journey. Diagnostic challenges remain tangible for many practicing clinicians, since there is lack of reliable cobalamin assays to diagnose CD as well as clinical mimics, which simulate many other hematological conditions, such as myelodysplastic syndrome, acute leukemia, sideroblastic anemias, bone marrow failure states, thrombotic microangiopathy, and thromboembolism. Moreover, prompt recognition of the symptoms of CD is also vital, because some neurologic sequalae may become irreversible despite replenishing cobalamin. Herein, we discuss a literature review on the pathophysiology, challenging clinical presentations and diagnostic difficulties of PA. Since the cobalamin replacement therapy for PA is straightforward, it will not be discussed in this review.
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Affiliation(s)
- Thura Win Htut
- Department of Hematology, Aberdeen Royal Infirmary Hospital, The University of Aberdeen, NHS Grampian, Scotland, UK
| | - Kyaw Zin Thein
- Department of Investigational Cancer Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Thein Hlaing Oo
- Section of Benign Hematology, The University of Texas MD Anderson Cancer Center, Houston, USA
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Clinical outcomes of proximal gastrectomy for gastric cancer: A comparison between the double-flap technique and jejunal interposition. PLoS One 2021; 16:e0247636. [PMID: 33626086 PMCID: PMC7904176 DOI: 10.1371/journal.pone.0247636] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/02/2021] [Indexed: 01/07/2023] Open
Abstract
Background The optimal reconstruction method after proximal gastrectomy (PG) has been debatable. Recent reports have shown that the double-flap technique (DFT) provides good outcomes in terms of postoperative nutritional status and quality of life. However, no study has compared the clinical outcomes of the DFT with other reconstruction methods. Here, we evaluated and compared the clinical outcomes between the DFT and jejunal interposition (JI) after PG for gastric cancer. Materials and methods The medical records of 34 consecutive patients who had undergone PG for upper third gastric cancer between January 2011 and October 2016 were reviewed retrospectively. The main factors investigated were surgical outcomes, postoperative nutritional status, symptoms, and endoscopic findings 1 year after surgery. Results Thirty-four patients were enrolled (DFT, 14; JI, 20). The operation time was similar between the two techniques (228 and 246 minutes for DFT and JI, respectively, P = 0.377), as were the rates of anastomotic complications (7% and 0% for DFT and JI, respectively, P = 0.412). Body weight loss was significantly lower in the DFT group than in the JI group (-8.1% vs -16.1%, P = 0.001). Total protein and albumin levels were higher in the DFT group than in the JI group (0% vs -2.9%, P = 0.053, and -0.3% vs -6.1%, P = 0.077, respectively). One patient in the DFT group and no patients in the JI group experienced reflux esophagitis (≥ grade B) (P = 0.393). Anastomotic strictures were not observed as postoperative complications in either group. Conclusions Surgical outcomes revealed that the DFT was safe and feasible, similar to JI. In terms of controlling postoperative body weight loss, the DFT is a better reconstruction technique than JI after PG.
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Fine EJ, Langan E, Lohr LA, Mages K. A British pathologist and child neurologist who described familial dementing disease and the neuropathology of subacute combined degeneration. JOURNAL OF THE HISTORY OF THE NEUROSCIENCES 2019; 28:76-85. [PMID: 30526291 DOI: 10.1080/0964704x.2018.1528131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Edward J Fine
- a Department of Neurology, Jacobs School of Medicine , University at Buffalo , Buffalo , New York , USA
| | - Emily Langan
- b Department of Neurology , Upstate Medical Center , Syracuse , New York , USA
| | - Linda A Lohr
- c Robert L. Brown, MD, History of Medicine Collection , University at Buffalo , Buffalo , New York , USA
| | - Keith Mages
- d Samuel J. Wood Library, Weil Cornell Medicine , New York , New York , USA
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Mooney FS, Heathcote JG. Oral Treatment of Pernicious Anaemia: Further Studies. BRITISH MEDICAL JOURNAL 2011; 1:232-5. [PMID: 20789044 DOI: 10.1136/bmj.1.5221.232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Whittingham S, Mackay IR. Autoimmune Gastritis: Historical Antecedents, Outstanding Discoveries, and Unresolved Problems. Int Rev Immunol 2009; 24:1-29. [PMID: 15763987 DOI: 10.1080/08830180590884413] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The earliest recorded history of autoimmune gastritis can be traced to 1849 in London, when Thomas Addison described "a very remarkable form of anemia" later called pernicious (fatal) anemia (PA). This was followed by the recognition of a gastric mucosal defect suspected to have a nutritional basis, the discovery of the megaloblast that characterized the anemia, the insufficiency of a dietary extrinsic factor characterized as vitamin B12 (cobalamin), and a gastric-secreted intrinsic factor. Treatment with vitamin B12 proved curative. The link between PA and gastritis and atrophy was first confirmed histologically after immediate fixation of the stomach postmortem and later, in the 1940s, by peroral tube biopsy. The causes of gastritis remained enigmatic until the era of autoimmunity, when autoantibodies were detected first to gastric intrinsic factor and then to gastric parietal cells. Hints of a dichotomy in pathogenesis of gastritis were crystallized by the description in 1973 of Type A (Autoimmune) and Type B (later, Bacterial) gastritis. Clarification was enhanced by identification in Type A gastritis of the autoantigen of the parietal cell antibody, by the alpha and beta subunits of gastric H+/K+ ATPase, and by the highly informative experimental murine model of postneonatal thymectomy autoimmune gastritis, and in Type B of the causative role of gastric infection with Helicobacter pylori (H. pylori). A denouement will require a full understanding of (1) the origin and pathogenetic contribution of antibody to intrinsic factor; (2) the connection, if any, between H. pylori infection and Type A autoimmune gastritis; and (3) the genetic contributions to gastritis, whether due to autoimmunity or to H. pylori infection.
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Affiliation(s)
- Senga Whittingham
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria, Australia.
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Sánchez-Fayos Calabuig P, Martín Relloso MJ, Porres Cubero JC. La mucosa gástrica como estructura diana de agresiones proinflamatorias persistentes: modelos patogénicos de gastritis crónica. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:294-306. [DOI: 10.1016/j.gastrohep.2008.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 05/05/2008] [Indexed: 12/19/2022]
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MOORE HC, LILLIE EW, GATENBY PB. The response of megaloblastic anaemia of pregnancy to vitamin B12. Ir J Med Sci 2008:106-16. [PMID: 14353575 DOI: 10.1007/bf02949682] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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De Block CEM, De Leeuw IH, Van Gaal LF. Autoimmune gastritis in type 1 diabetes: a clinically oriented review. J Clin Endocrinol Metab 2008; 93:363-71. [PMID: 18029461 DOI: 10.1210/jc.2007-2134] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONTEXT Autoimmune gastritis and pernicious anemia are common autoimmune disorders, being present in up to 2% of the general population. In patients with type 1 diabetes or autoimmune thyroid disease, the prevalence is 3- to 5-fold increased. This review addresses the epidemiology, pathogenesis, diagnosis, clinical consequences, and management of autoimmune gastritis in type 1 diabetic patients. SYNTHESIS Autoimmune gastritis is characterized by: 1) atrophy of the corpus and fundus; 2) autoantibodies to the parietal cell and to intrinsic factor; 3) achlorhydria; 4) iron deficiency anemia; 5) hypergastrinemia; 6) pernicious anemia may result from vitamin B12 deficiency; and 7) in up to 10% of patients, autoimmune gastritis may predispose to gastric carcinoid tumors or adenocarcinomas. This provides a strong rationale for screening, early diagnosis, and treatment. The management of patients with autoimmune gastritis implies yearly determination of gastrin, iron, vitamin B12 levels, and a complete blood count. Iron or vitamin B12 should be supplemented in patients with iron deficiency or pernicious anemia. Whether regular gastroscopic surveillance, including biopsies, is needed in patients with autoimmune gastritis/pernicious anemia is controversial. The gastric carcinoids that occur in these patients generally do not pose a great threat to life, whereas the danger of developing carcinoma is controversial. Nevertheless, awaiting a consensus statement, we suggest performing gastroscopy and biopsy at least once in patients with autoantibodies to the parietal cell, iron-, or vitamin B12-deficiency anemia, or high gastrin levels. CONCLUSION The high prevalence of autoimmune gastritis in type 1 diabetic patients and its possible adverse impact on the health of the patient provide a strong rationale for screening, early diagnosis, periodic surveillance by gastroscopy, and treatment.
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MESH Headings
- Anemia, Pernicious/complications
- Anemia, Pernicious/immunology
- Anemia, Pernicious/pathology
- Anemia, Pernicious/therapy
- Autoantibodies/blood
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/immunology
- Diabetes Mellitus, Type 1/pathology
- Diabetes Mellitus, Type 1/therapy
- Gastritis, Atrophic/complications
- Gastritis, Atrophic/immunology
- Gastritis, Atrophic/pathology
- Gastritis, Atrophic/therapy
- Humans
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Affiliation(s)
- Christophe E M De Block
- Department of Diabetology-Endocrinology, Antwerp University Hospital and University of Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium.
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HERBERT V. Mechanism of intrinsic factor action in everted sacs of rat small intestine. J Clin Invest 2000; 38:102-9. [PMID: 13620774 PMCID: PMC444117 DOI: 10.1172/jci103779] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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KAPLAN ME, ZALUSKY R, REMINGTON J, HERBERT V. Immunologic studies with intrinsic factor in man. J Clin Invest 1998; 42:368-82. [PMID: 14030747 PMCID: PMC289289 DOI: 10.1172/jci104723] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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FARRANT PC. Nuclear changes in squamous cells from buccal mucosa in pernicious anaemia. BRITISH MEDICAL JOURNAL 1998; 1:1694-7. [PMID: 13821623 PMCID: PMC1967712 DOI: 10.1136/bmj.1.5187.1694] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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WEINSTEIN IB, WEISSMAN SM, WATKIN DM. The plasma vitamin B12 binding substance. I. Its detection in the seromucoid fraction of plasma from normal subjects and patien with chronic myelocytic leukemia. J Clin Invest 1998; 38:1904-14. [PMID: 13843622 PMCID: PMC441777 DOI: 10.1172/jci103968] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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NIEBURGS HE, GLASS GB. Gastric-cell maturation disorders in atrophic gastritis, pernicious anemia, and carcinoma. Histologic site of origin and diagnostic significance of abnormal cells. ACTA ACUST UNITED AC 1998; 8:135-59. [PMID: 13938480 DOI: 10.1007/bf02232657] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- B H Toh
- Department of Pathology and Immunology, Monash University Medical School, Prahran, Victoria, Australia
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DiBiase MD, Morrel EM. Oral delivery of microencapsulated proteins. PHARMACEUTICAL BIOTECHNOLOGY 1997; 10:255-88. [PMID: 9160376 DOI: 10.1007/0-306-46803-4_10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Chapter 45 Vitamin B12. ACTA ACUST UNITED AC 1997. [DOI: 10.1016/s1569-2582(97)80106-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
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Affiliation(s)
- J P Glusker
- Institute for Cancer Research, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111
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Krasinski SD, Russell RM, Samloff IM, Jacob RA, Dallal GE, McGandy RB, Hartz SC. Fundic atrophic gastritis in an elderly population. Effect on hemoglobin and several serum nutritional indicators. J Am Geriatr Soc 1986; 34:800-6. [PMID: 3771980 DOI: 10.1111/j.1532-5415.1986.tb03985.x] [Citation(s) in RCA: 137] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The ratio of pepsinogen I to pepsinogen II in the circulation decreases progressively with increasing severity of atrophic gastritis of the fundic gland mucosa. Fasting blood was obtained from 359 free-living and institutionalized elderly people (age range, 60 to 99 years). A pepsinogen I/pepsinogen II ratio less than 2.9, indicating atrophic gastritis, was found in 113 (31.5%) subjects. The prevalence of atrophic gastritis increased significantly with advancing age (P less than .05). Within the atrophic gastritis group, 84 had a pepsinogen I level greater than or equal to 20 micrograms/L, indicating mild to moderate atrophic gastritis, and 29 had a pepsinogen I level less than 20 micrograms/L, indicating severe atrophic gastritis or gastric atrophy. A significant increase in the prevalences of elevated serum gastrin levels (P less than .005), low serum vitamin B12 levels (P less than .005), circulating intrinsic factor antibody (P less than .005), and anemia (P less than .025) was observed with stepwise increases in severity of atrophic gastritis. Subjects with atrophic gastritis exhibited a lower mean serum vitamin B12 level (P less than .05) and a higher mean folate level (P less than .05), but no difference was detected in mean hemoglobin levels or serum levels of iron, ferritin, retinol or alpha-tocopherol. It is concluded that serum pepsinogen I and pepsinogen II levels can be used to determine the prevalence and severity of atrophic gastritis, that atrophic gastritis is common in an elderly population, and that atrophic gastritis is associated with vitamin B12 deficiency and anemia. Further, higher folate levels in atrophic gastritis may be related to an accumulation of 5-methyl tetrahydrofolate in serum due to vitamin B12 deficiency and/or greater folate synthesis by the intestinal flora resulting from bacterial overgrowth secondary to hypo- or achlorhydria.
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Abstract
Although readily treatable with vitamin B12, pernicious anemia continues to captivate investigative endeavors of those interested in the pathophysiology and pathogenesis of this disorder. Notable advances have been made in understanding properties of intrinsic factor, vitamin B12-binding proteins, structure and de novo synthesis of vitamin B12, mechanism of action of vitamin B12-dependent enzymes in man, and metabolic consequences of reduced activities of these enzymes in pernicious anemia. Similarly, newer morphological observations have given information regarding pathogenesis of some of the cytological abnormalities found in megaloblasts, and recent cytochemical studies have shed light on abnormalities of nuclear and cytoplasmic constituents in vitamin B12-deficient cells. Both cellular and humoral factors may contribute to immune-mediated processes in pernicious anemia, although as yet, it has not been established with certainty that pernicious anemia is an autoimmune disorder. As we look ahead, it will be important to define the process or processes responsible for atrophic gastritis, which is the pathophysiological basis of pernicious anemia. Likewise, advances in biophysics used in the study of cell membranes, cell surface phenomena, and metallic ion transport may find applicability in the study of pernicious anemia and perhaps provide further insights into metabolic abnormalities responsible for the development of megaloblastosis.
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Affiliation(s)
- L Kass
- Department of Internal Medicine, University of Michigan, Ann Arbor
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Friedman PA, Shia MA, Wallace JK. A saturable high affinity binding site for transcobalamin II-vitamin B12 complexes in human placental membrane preparations. J Clin Invest 1977; 59:51-8. [PMID: 830665 PMCID: PMC333331 DOI: 10.1172/jci108621] [Citation(s) in RCA: 60] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Studies were designed to evaluate the binding of binding of vitamin B12 to cell membrane preparations from human placenta. The transcobalamin II-vitamin B12 complex (TCII-B12), which has a much greater affinity for the membranes than vitamin B12 alone, binds to a single saturable binding site with an approximate Ka = 7.2 mM-1. The binding requires a divalent cation and is temperature-dependent. Free TCII can compete with TCII-B12 for the binding site but has somewhat less affinity than does TCII-B12. Rat TCII-B12 has an affinity constant that is less than one-fifth that of human TCII-B12; human TCI-B12, bovine TCII-B12, hog intrinsic factor-B12 (IF-B12), and human IF-B12 do not bind to the membranes. Pretreating the membranes with trypsin causes a marked decrease in subsequent binding; this suggests the binding site includes a relatively exposed membrane protein. These data suggest that a specific cell surface receptor for the TCII-B12 complex exists in placenta. This TCII-B12 receptor can be solubilized with Triton X-100.
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Fiedler-Nagy C, Rowley GR, Coffey JW, Miller ON. Binding of vitamin B12--rat transcobalamin II and free vitamin B12 to plasma membranes isolated from rat liver. Br J Haematol 1975; 31:311-21. [PMID: 1201244 DOI: 10.1111/j.1365-2141.1975.tb00862.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
When dialysed rat serum which contains a single, low molecular weight binder for vitamin B12, rat transcobalamin II (rat TC-II), was labelled in vitro with 57Co-vitamin B12 and then incubated at 30 degrees C (pH 7-5) with vesicles of highly purified plasma membranes separated from microsomal fractions of rat liver by density gradient centrifugation, the 57Co-vitamin B12-rat TC-II complex bound to high affinity sites on the vesicles via a specific (binding after correction for 'non-specific' binding in the presence of a large excess of the non-radioactive complex), saturable, and reversible interaction. The apparent affinity constant for the binding reaction was 5-5 X 10(9) M-1. Using the same incubation conditions, free vitamin B12 also bound to the vesicles of plasma membranes via a specific, saturable, but apparently irreversible interaction. Preincubation of the membranes with free vitamin B12 did not interfere with the subsequent binding of the vitamin B12-rat TC-II complex to the membranes; however, preincubation with the vitamin B12-rat TC-II complex did interfere, to some extent, with the subsequent binding of free vitamin B12. Dialysed rat serum, perhaps the free rat TC-II in the dialysed serum, also inhibited the binding of the vitamin B12-rat TC-II complex to the plasma membranes. The relationship of the binding sites identified in this report to the absorption of vitamin B12 by rat liver, and thus their physiological significance remains unknown until further work is done, perhaps using intact hepatocytes.
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Vitamin B12 and Folic Acid. Blood 1974. [DOI: 10.1016/b978-0-12-595705-2.50020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Davis WW, Kreutler CJ. Normal and promoted GI absorption of water-soluble substances. II. Absorption of vitamin B 12 from ligated stomach and intact intestine of the rat. J Pharm Sci 1971; 60:1651-4. [PMID: 5133913 DOI: 10.1002/jps.2600601112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Mooney FS, Heathcote JG. Oral treatment of pernicious anaemia: first fifty cases. BRITISH MEDICAL JOURNAL 1966; 1:1149-51. [PMID: 5932076 PMCID: PMC1844112 DOI: 10.1136/bmj.1.5496.1149] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Heathcote JG, Washington R. Amino-acids and peptides in human gastric juice with particular reference to pernicious anaemia: a review. Nature 1965; 207:941-4. [PMID: 5329038 DOI: 10.1038/207941a0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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SULLIVAN LW, HERBERT V. STUDIES ON THE MINIMUM DAILY REQUIREMENT FOR VITAMIN B12. HEMATOPOIETIC RESPONSES TO 0.1 MICROGM. OF CYANOCOBALAMIN OR COENZYME B12, AND COMPARISON OF THEIR RELATIVE POTENCY. N Engl J Med 1965; 272:340-6. [PMID: 14239115 DOI: 10.1056/nejm196502182720703] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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UCHINO H, SCHWARTZ GH, GLASS GB. Effects of peptic digestion, pH change and heating on B12 binders in the electrophoretic partition of the human gastric juice. Clin Chim Acta 1964; 9:474-84. [PMID: 14185812 DOI: 10.1016/0009-8981(64)90085-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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HIGHLEY DR, ELLENBOGEN L. Studies on the mechanism of vitamin B12 absorption: in vivo transfer of vitamin B12 to intrinsic factor. Arch Biochem Biophys 1962; 99:126-31. [PMID: 13954417 DOI: 10.1016/0003-9861(62)90254-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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HEATHCOTE JG, MOONEY FS. Oral Treatment of Pernicious Anæmia with a Vitamin B12/L~Glutamic Acid Mixture. Nature 1962; 193:380-1. [PMID: 13905799 DOI: 10.1038/193380a0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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CANELAS MH. Mieloses funiculares considerações a propósito de 110 casos. ARQUIVOS DE NEURO-PSIQUIATRIA 1960; 18:105-32. [PMID: 13807410 DOI: 10.1590/s0004-282x1960000200001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
O autor, revendo o conceito atual da etiopatogenia das mieloses funiculares, conclui que, na determinação do processo desmielinizante, além da carência de vitamina B12 e da acloridria gástrica, participam outros fatores, carenciais e/ou alérgicos. Baseado no estudo de 110 casos com lesões gástricas constitucionais (100 casos) ou adquiridas (10 casos), o autor discute o problema do diagnóstico. São consideradas as síndromes periférica, funicular dorsal, "piramidal" e encefálica. É ressaltada a importância do exame da sensibilidade vibratória, particularmente por método quantitativo, que revelou, em elevada percentagem dos casos, distúrbios da palestesia também nas mãos. Entre os exames complementares, é salientado o valor do hemograma, do mielograma, da dosagem da acidez gástrica, da determinação da absorção da vitamina B12 radioativa; são também consideradas as alterações electrencefalográficas e do liqüido cefalorraqueano. Os resultados terapêuticos em 44 casos são avaliados através do estudo semiquantitativo da sintomatologia neurológica. Embora a vitamina B12 tenha proporcionado maiores índices de melhora, os demais medicamentos (extrato hepático, ácido fólico e adrenocorticotropina) também influenciaram favoravelmente o quadro neurológico. Em vista da pequena representação numérica da casuística nos grupos correspondentes aos quatro esquemas terapêuticos, o autor não emite conclusão definitiva. Salienta, porém, que êsses resultados demonstram a necessidade de prosseguir nos estudos sôbre a etiopatogenia das mieloses funiculares, no sentido de esclarecer as numerosas incógnitas que ainda perduram.
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McINTYRE PA, KREVANS JR, CONLEY CL. Treatment of megaloblastic anemias. JOURNAL OF CHRONIC DISEASES 1957; 6:287-301. [PMID: 13475434 DOI: 10.1016/0021-9681(57)90024-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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42
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BOOTH CC, CHANARIN I, ANDERSON BB, MOLLIN DL. The site of absorption and tissue distribution of orally administered 56Co-labelled vitamin B12 in the rat. Br J Haematol 1957; 3:253-61. [PMID: 13460194 DOI: 10.1111/j.1365-2141.1957.tb05794.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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STRANDELL B, TOMENIUS J, STROM S. The vitamin B12 binding effect of the gastric mucosa. ACTA MEDICA SCANDINAVICA 1957; 157:179-83. [PMID: 13424125 DOI: 10.1111/j.0954-6820.1957.tb14424.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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VICTOR M, LEAR AA. Subacute combined degeneration of the spinal cord; current concepts of the disease process; value of serum vitamin B12; determinations in clarifying some of the common clinical problems. Am J Med 1956; 20:896-911. [PMID: 13326904 DOI: 10.1016/0002-9343(56)90210-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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48
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KREVANS JR, CONLEY CL, SACHS MV. Radioactive tracer tests for the recognition and identification of vitamin B12 deficiency states. JOURNAL OF CHRONIC DISEASES 1956; 3:234-52. [PMID: 13295353 DOI: 10.1016/0021-9681(56)90120-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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BLACKBURN EK, COHEN H, WILSON GM. Oral treatment of pernicious anaemia with a combined vitamin B12 and intrinsic factor preparation. BRITISH MEDICAL JOURNAL 1955; 2:461-3. [PMID: 13240149 PMCID: PMC1980614 DOI: 10.1136/bmj.2.4937.461] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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50
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ZAMCHECK N, GRABLE E, LEY A, NORMAN L. Occurrence of gastric cancer among patients with pernicious anemia at the Boston City Hospital. N Engl J Med 1955; 252:1103-10. [PMID: 14383972 DOI: 10.1056/nejm195506302522601] [Citation(s) in RCA: 80] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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