The xylose excretion test

It is thought that this simple and useful procedure can give valuable information on the state of carbohydrate absorption. Details of the determination are presented and the rationale of the test discussed. Diseases associated with defection absorption, such as celiac disease, Whipple's disease, scleroderma, pernicious anemia and certain post-operative states are illustrated. It is suggested that the presence of ascites may account for the low values encountered in some patients with hepatic cirrhosis (AU)

Pernicious anaemia in Jamaica

Clinical and laboratory details are given on 10 negro patients with pernicious anaemia admitted to the University College Hospital in Jamaica in the 30 months from January, 1958, to June, 1960. All showed the usual clinical and laboratory features of pernicious anaemia; and in the patients on whom these tests were carried out the Schilling test and gastric biopsy findings were characteristic. Anorexia and loss of weight were conspicuous features. It is thought that the rarity of this disease in the negro has been overemphasized and that hospital statitics may be misleading in this respect. The literature on pernicious anaemia in other parts of the tropics is briefly reviewed. There is evidence that, in addition to the basic gastric lesion, dietary and economic factors may play a part in the genesis of the disease (AU)

Non-Addisonian vitamin B12 deficiency anaemia in Trinidad (abstract only)

Of 12 cases of megaloblastic anaemia in adults not associated with pregnancy seen during the period 1st April, 1959 to 31st January, 1960, six cases were of Non- Addisonian type. Four cases were Addisonian type and the remaining two cases died before full work up had been done. With one exception Vitamin B12 in a dose of 100 micrograms I.M. daily was the only haematinic used. In the single exception folic acid was given in addition on the sixth day after a reticulocyte and clinical response to Vitamin B12 had been noted. It was therefore, believed to be established that the anaemia in the Non-Addisonian group could be corrected completely by the use of Vitamin B12 only. The noteworthy features in this Non-Addisonian group were as follows:- All were Hindus and with one exception these were strict vegetarians eating no eggs, meat, fowl or fish. The grounds for these dietary prohibitions appeared to be religious. Severe mental symptoms were nearly always present, namely, intellectual dullness, amnesia and confusion with frankly psychotic reactions in two patients. These mental symptoms improved following treatment. Other features of this group were sore tongue (2 cases), fever (4 cases), icterus (4 cases) and splenomegaly (2 cases). The pyrexia appears to be related solely to the specific deficiency. The low levels of Hb (none above 30 percent) observed in this group at time of diagnosis, suggests that early cases are for some reason being missed. The status of the two patients who died before full work up is uncertain. One may belong to the Non- Addisonian group. No unusual features were noted among the four cases of Addisonian anaemia. The incidence of this condition among non-European peoples may be higher than previously suspected. The pathogenesis of non-Addisonian B12 deficiency is discussed. It is suggested that poverty and a vegetarian diet combine in certain individuals to produce this state. Vitamin B12 rather than folic acid deficiency develops presumably because folic acid is widely distributed among leafy vegetables. (However, no special folic acid studies were done) (AU)