[Multifocal gastric carcinoid associated with anemia caused by vitamin B12 deficiency: demonstration of in situ production of serotonin].
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Biomedical subjects
Publications and source records attributed to F Bodin.
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The aim of this work was to show that the dynamic study of the amino acid pattern in plasma and urine following an oral load of tryptophan might confirm anomalies suggested by inconsistent clinical data and below-normal biological values. Such oral loads were administered to five control subjects and one patient who had recovered from a celiac condition but was suffering from a complex deficiency syndrome associating a polyneuritis due to a lack of folic acid and the excretion of blue-colored transpiration. Thirty minutes following the load a slowing in the rate of tryptophan absorption was observed (p less than 0.05) and, during the first 6 hours, increased urinary excretion of tryptophan (p less than 0.01) and indican (p less than 0.05). Similarly, changes in the metabolism of other amino acids were either revealed or accentuated by this oral load test (ornithine, glycine, lysine, phenylalanine). It is probable that in this patient a problem of tubular re-absorption led to tryptophan being less available for metabolization along the kynurenine pathway, accounting for the increase in urinary excretion of the amino acids concerned. The diagnosis put forward is that of an unexpressed form of Hartnup's disease in association with a folic acid deficiency.
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The authors report two cases of hepatitis and a case of pancreatitis associated with indalpine. In one case of hepatitis, onset was acute and the clinical presentation was suggestive of cholecystitis; in the other case, hepatitis was discovered by biological tests. In the two cases, hepatitis was mainly cytolytic. Outcome was favorable upon interruption of drug administration. Onset of pancreatitis was inconspicuous, with progressively increasing pain. The pancreatic lesions were diffuse and massive. After interruption of administration, outcome was eventually favorable. Elevated amylasemia was also noted in the two cases of hepatitis. It is suggested that transaminase and amylase activities should be monitored during indalpine therapy.
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A case of extensive squamous cell carcinoma of the esophagus in a 56 year old man, with an history of excessive alcoholic and tobacco consumption, is reported. After subtotal esophagectomy, the course was favorable 10 months after surgery. The pathological study of the surgical specimen showed that the tumor was superficial and confined to the mucosa and submucosa. The lesion measured 65 mm in length (after fixation) and was circumferential. Foci of moderate and severe dysplasia and inflammatory erosions were also observed. The relationship between extensive squamous cell carcinoma, dysplasia, esophagitis and the concept of "carcinogenic fields" are discussed. The necessity of large radical resection of the esophagus is emphasized.
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The megaloblastic anaemia observed in patients with chronic atrophic gastritis is usually due to malabsorption of vitamin B12. In some cases, the absence of intrinsic factor supports the diagnosis of pernicious anaemia but other factors, the importance of which varies from case to case, are also involved. They include proliferation of bacteria in the lumen of the gut, intestinal cell abnormalities resulting from lack of vitamin B12 and low hydrochloric acid output with subsequent reduction in the release of vitamin B12 from foodstuffs. With regard to treatment, it would seem justified to combine oral broad-spectrum antibiotics with parenteral administration of vitamin B12.
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The authors report a case of urticaria pigmentosa with systemic mastocytosis and review the literature on this occasion. The onset of the disease was marked by the development of ascites. Ascites is rarely mentioned in this affection and remains, as with other manifestations of systemic mastocytosis, without any explanation. The diagnosis was established first on the diffuse mastocyte-infiltration especially in the bone-marrow and second, on the hypersecretion of hormonal factors especially histamine by mastocytes. The symptomatic treatment of this affection is based on histamine inhibitors and disodium cromoglycate seems to be an efficient drug. With the possible development of acute leukemia, the eventual association with a carcinoma and the frequency of serious digestive bleeding, the prognosis may be very poor.
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Six patients developed acute, subacute or chronic hepatitis after taking tielinic acid, a new diuretic used in the treatment of hypertension. Two died of acute liver failure. The condition was characterized by marked increase in serum transaminases, parenchymal necrosis and portal and/or lobular inflammatory fibrosis. In addition, the serum of all patients contained high titers of a liver/kidney microsomal antibody, which disappeared either after tienilic acid was discontinued or after prednisolone was introduced. The study shows that tienilic acid may be responsible for acute or chronic hepatitis and suggests that a liver/kidney microsomal antibody could be a sero-immunological marker of drug-induced liver disease.