Cases reported "Anemia, Pernicious"

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1/183. autoantibodies to gastrin in patients with pernicious anaemia--a novel antibody.

    autoantibodies arise when there is a breakdown in immunological tolerance. autoantibodies to parietal cells and intrinsic factor are found in autoimmune atrophic gastritis (AAG) and are associated with elevated plasma gastrin. Endogenous gastrin autoantibodies have not been described to date. The aim of this study was to investigate the occurrence of autoantibodies to gastrin. plasma from 50,000 patients, including more than 2000 with AAG, was tested. Gastrin was measured by radioimmunoassay (RIA) in whole plasma and the presence of autoantibody determined by using a control which omitted assay antibody. The quantity and affinity of gastrin autoantibodies was assessed. Three patients had autoantibodies to gastrin. All three had AAG and pernicious anaemia (PA). The antibodies were of low titre and relatively high affinity. Free circulating plasma gastrin levels were within the normal range, but total gastrin levels were elevated. This is the first description of autoantibodies to endogenous gastrin. The incidence of antibodies to gastrin is low, they are found in association with PA, and they may lead to falsely low measurements of plasma gastrin. ( info)

2/183. MRI in vitamin B12 deficiency myelopathy.

    BACKGROUND: Little is known about vitamin B12 deficiency myelopathy's magnetic resonance imaging (MRI) manifestations and their relationship to the onset, evolution, and resolution of neurologic signs and symptoms. methods: We present a case and review eleven additional reported cases of subacute combined degeneration of the spinal cord detected by MRI. RESULTS: Our patient had increased T2-weighted signal and gadolinium contrast enhancement of the posterior columns in the cervical and thoracic regions and enhancement of the lateral columns in the high cervical region. This is a case with imaging evidence for lateral column lesions. Two prior reports have shown posterior column enhancement. T1-weighted images may show decreased signal in the posterior columns and sometimes demonstrate reversible spinal cord swelling. MRI abnormalities typically improve after vitamin replacement therapy. However, clinical signs may persist despite resolution of imaging abnormalities, and these abnormalities do not always resolve completely. In addition, symptoms may precede the imaging abnormality. CONCLUSIONS: Vitamin B12 deficiency may produce an increased T2-weighted signal, decreased T1-weighted signal, and contrast enhancement of the posterior and lateral columns of the spinal cord, mainly of the cervical and upper thoracic segments. Because the symptoms may precede any imaging abnormality, it is clear that spinal cord MRI may not be a highly sensitive, early test for subacute combined degeneration. ( info)

3/183. Unusual gastrointestinal features in a child with pernicious anemia.

    Pernicious anemia in childhood is a rare disease. The radiologic demonstration of gastric mucosal atrophy led directly to this diagnosis in an 11-year-old girl. In addition, there was deformity of the pyloric antrum and superficial ulceration in the stomach and duodenum. endoscopy and biopsy confirmed these findings. ( info)

4/183. Primary antiphospholipid syndrome associated with pernicious anaemia.

    AIM: To determine whether there is an association between pernicious anaemia and antiphospholipid antibody syndrome. methods: Fifteen patients with pernicious anaemia and 11 patients with iron deficiency anaemia (controls) were evaluated for clinical parameters of thrombosis and/or the presence of antiphospholipid antibodies, antinuclear antibodies or lupus anticoagulant. RESULTS: One asymptomatic patient with pernicious anaemia had laboratory features suggestive of the antiphospholipid syndrome. An additional three patients in each group had slightly elevated antiphospholipid antibody concentrations, within one standard deviation of the normal range. CONCLUSION: The association between pernicious anaemia and antiphospholipid antibody syndrome is rare and evaluation should be guided by clinical indications. ( info)

5/183. Medico-dental dilemmas.

    patients with a variety of diseases in the oro-facial region are frequently confused when trying to decide from which of the professions of medicine and dentistry to seek treatment. Furthermore, during the process of arriving at a diagnosis, numerous practitioners and specialists in both professions may be called in for consultation, thus adding to the dilemma. Four cases are reported in this article to illustrate the problem, and some conclusions are drawn as to how it may be minimized albeit not completely solved. ( info)

6/183. Subcutaneous sarcoidosis associated with vitiligo, pernicious anaemia and autoimmune thyroiditis.

    We report a patient with pernicious anaemia, primary autoimmune hypothyroidism and vitiligo, who presented with subcutaneous nodules. Histopathology of the nodules revealed noncaseating granulomas, consistent with a diagnosis of sarcoidosis. Mild pulmonary sarcoid was also detected. Although an association between sarcoidosis and other autoimmune diseases is well-recognized, the presence of the particular autoimmune diseases in our patient and the involvement of subcutaneous fat in the sarcoidal inflammation, appears to represent a most unusual clinicopathological combination. ( info)

7/183. Relationship between pernicious anaemia and gastric neuroendocrine cell disorders.

    The incidence of gastric carcinoid tumours is increasing. This rise is probably due to the number of gastroscopies and improved histological techniques. The majority (65%) of these gastric tumours is associated with chronic atrophic gastritis and pernicious anaemia. In this article two patients are presented, one with pernicious anaemia and gastric neuroendocrine cell hyperplasia and one with pernicious anaemia and multiple gastric carcinoids. These neuroendocrine cell disorders have a relatively favourable prognosis. Therefore, a wait-and-see policy was preferred. The pathogenesis, clinical symptoms, diagnosis, prognosis and treatment of these different neuroendocrine cell manifestations are discussed. We recommend performing a gastroscopy at the time of diagnosis for young patients with pernicious anaemia, and whenever abdominal problems, unexplained weight loss or aggravation of the anaemia arise. ( info)

8/183. nitrous oxide anesthesia-associated myelopathy.

    BACKGROUND: The role of nitrous oxide exposure in neurologic complications of subclinical cobalamin deficiency has been reported, but few cases are well documented. observation: Two weeks after surgery for prosthetic adenoma, a 69-year-old man developed ascending paresthesia of the limbs, severe ataxia of gait, tactile sensory loss on the 4 limbs and trunk, and absent tendon reflexes. After a second surgical intervention, the patient became confused. Four months after onset, the patient had paraplegia, severe weakness of the upper limbs, cutaneous anesthesia sparing the head, and confusion. Moderate macrocytosis, low serum B12 levels, and a positive schilling test result led to the diagnosis of pernicious anemia. Results of electrophysiologic examinations showed a diffuse demyelinating neuropathy. magnetic resonance imaging of the spinal cord disclosed hyperintensities of the dorsal columns on T2-weighted images. CONCLUSIONS: Pernicious anemia can result in severe neurologic symptoms with only mild hematologic changes. The role of nitrous oxide anesthesia in revealing subclinical B12 deficiency must be emphazised. magnetic resonance imaging of the spinal cord might be helpful in making the diagnosis. ( info)

9/183. Gastric carcinoid tumours and pernicious anemia: case report and review of the literature.

    patients with pernicious anemia are at risk of developing carcinoid tumours of the stomach. A patient with pernicious anemia and multifocal carcinoid tumours of the gastric fundus that regressed after antrectomy is presented. The frequent occurrence of gastric carcinoid tumours in patients with long-standing pernicious anemia suggests that surveillance gastroscopy and biopsies of the fundus might be indicated. Compete functional antrectomy may effectively cause these tumours to regress by removing their excessive gastrin hormonal stimulation. However, incomplete antrectomy can result in persistently elevated serum gastrin and failure of total disappearance of the carcinoid tumours. ( info)

10/183. Pernicious anemia, gastric carcinoid, and autoimmune thrombocytopenia in a young woman.

    The association between gastric carcinoid tumors and pernicious anemia is well recognized. Such tumors occur in the presence of achlorhydria, chronic atrophic gastritis, hypergastrinemia, and enterochromaffin-like cell hyperplasia. In this case report, a 29-year-old woman with pernicious anemia and autoimmune thrombocytopenia who developed gastric carcinoid tumors of the gastric body is described. This is the second description of pernicious anemia associated with autoimmune thrombocytopenia. This association in a young woman together with the therapeutic options and decisions that were taken in the treatment of the patient are discussed. ( info)
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