Should we monitor vitamin B12 levels in patients who have had end-ileostomy for inflammatory bowel disease?

BACKGROUND AND AIMS

We examined whether vitamin B12 levels are low following surgery in those patients who have had end-ileostomy for inflammatory bowel disease.

PATIENTS AND METHODS

This prospective observational study used the database of a university teaching hospital to identify patients with inflammatory bowel disease with an end-ileostomy constructed more than 30 months previously. Precise diagnosis, disease distribution and details of their surgery were collected from case notes of the 39 eligible patients (18 Crohn's disease, 17 ulcerative colitis, 4 indeterminate colitis). Mean duration since ileostomy formation was 12.53 years. Patients found to be vitamin B12 deficient underwent further investigations to ascertain the cause of their vitamin B12 deficiency (<150 ng/l).

RESULTS

There was no significant difference between serum vitamin B12 levels in patients with Crohn's disease and those in patients with ulcerative colitis following end ileostomy formation. Two patients (5.1%) were identified as having vitamin B12 deficiency. One of these had had a panproctocolectomy for Crohn's disease, followed by subsequent resection for ileal obstruction and ongoing small intestinal disease. The other had had colectomy for ulcerative colitis, in whom no cause other than the ileostomy was found for the vitamin B12 deficiency. There was no significant correlation between serum vitamin B12 levels and duration of ileostomy overall or in the disease subgroups.

CONCLUSION

We do not recommend routine screening for vitamin B12 deficiency in this group of patients unless they have undergone additional small bowel resection or have ongoing small bowel inflammation.

Short intramolecular S...O interactions in S-substituted 2-mercaptoacetophenones

The non-bonded S...O intramolecular interactions in the title compounds 2-(phenylthio)acetophenone [IUPAC: 2-[2-(phenylsulfanyl)phenyl]ethanone], C(14)H(12)OS, and 2-(benzylthio)acetophenone [IUPAC: 2-[2-(benzylsulfanyl)phenyl]ethanone], C(15)H(14)OS, are unusually short, indicating the contribution of heterocyclic oxathiole-type resonance structures to the overall bonding.

Rate of response as a visual social stimulus

In Exp. 1, a high rate of responding (chain pulling) of a stimulus monkey was established as a visual positive discriminative stimulus for the operant behavior (bar pressing) of an observer monkey. The terminal performance of the observer under conditions in which a high rate of response of the stimulus monkey alternated in a variable temporal arrangement with a zero rate of response of the stimulus monkey (negative discriminative stimulus) was essentially the same as when nonbehavioral stimuli are correlated with the availability of reinforcement. By manipulating the schedule of reinforcement to change the rate of responding of the stimulus subject without changing its rate of reinforcement, Exp. 2 showed that the effective behavioral stimulus for the observer was the rate of chain pulling by the stimulus subject. A novel intermediate rate of responding by the stimulus monkey resulted in an intermediate rate (generalization) on the part of the observer during an extinction test. These experiments demonstrated that the rate of responding of one organism can function as a discriminative stimulus to control the rate of responding of another organism; and that the rate of responding is similar to other physical stimuli in terms of discrimination and generalization.