Evaluation of indicators of cobalamin deficiency defined as cobalamin-induced reduction in increased serum methylmalonic acid.

BACKGROUND: Early detection of cobalamin deficiency is clinically important, and there is evidence that such deficiency occurs more frequently than previously anticipated. However, serum cobalamin and other commonly used tests have limited ability to diagnose a deficiency state. METHODS: We investigated the ability of hematological variables, serum cobalamin, plasma total homocysteine (tHcy), serum and erythrocyte folate, gastroscopy, age, and gender to predict cobalamin deficiency. Patients (n = 196; age range, 17-87 years) who had been referred from general practice for determination of serum cobalamin were studied. Cobalamin deficiency was defined as serum methylmalonic acid (MMA) >0.26 micromol/L with at least 50% reduction after cobalamin supplementation. ROC and logistic regression analyses were used. RESULTS: Serum cobalamin and tHcy were the best predictors, with areas under the ROC curve (SE) of 0. 810 (0.034) and 0.768 (0.037), respectively, but age, intrinsic factor antibodies, and gastroscopy gave additional information. CONCLUSIONS: When cobalamin deficiency is suspected in general practice, serum cobalamin should be the first diagnostic test, and the result should be interpreted in relation to the age of the patient. When a definite diagnosis cannot be reached, MMA and tHcy determination will provide additional discriminative information, but MMA, being more specific, is preferable for assessment of cobalamin status.

[Human T-cell lymphotrophic virus type I and T-cell lymphoma]. / Humant T-cellelymfotropt virus type I og T-cellelymfom.

Human T-cell lymphotropic virus type I is an oncogenic retrovirus, endemic in Southwestern Japan, the Caribbean, some parts of Africa and Central and South America. The virus is etiologically associated with adult T-cell leukemia/lymphoma and a myelopathy called tropical spastic paraparesis or HTLV-I associated myelopathy. Transmission of the virus is almost identical to that of HIV. The latency period before onset of clinical symptoms can last from a few years (tropical spastic paraparesis) up to several decades (adult T-cell leukemia/lymphoma). Four different clinicopathological subtypes of the T-cell neoplasia are known, and in this article we describe two patients with the subtype lymphoma.

[Immunologic manifestations in myelodysplastic syndrome]. / Immunologiske manifestasjoner ved myelodysplastisk syndrom.

We describe three patients with primary myelodysplastic syndrome and immunological manifestations. One had painful cutaneous plaques, arthritis and peripheral neuropathy, another showed cutaneous vasculitis, and a third had Sweet's syndrome. All patients responded dramatically to steroids. Before treatment the patient with Sweet's syndrome had high serum levels of interleukin 6 (IL-6), which were reduced to zero after treatment with steroids. Myelodysplastic syndrome should be considered when evaluating patients with immunological or rheumatic manifestations associated with one or more cytopenias.

[Quality assurance in clinical medicine--from theory to practice]. / Kvalitetssikring i klinisk medisin--fra teori til handling.

So far, in Norway, quality assurance methodology has been applied mainly within medical technology, and it is now high time to involve clinical medicine. In order to develop quality assurance as a continuous process in clinical departments there is a need for clinical data programmes. Moreover, leaders of health institutions and departments must make available the necessary funds. Greater efforts must be made to develop quality standards and indicators. Clinicians need to improve their knowledge of quality assurance methods, and develop guidelines for practice, different methods of consensus, medical audits and quality circles. It is proposed that education in quality assurance be included in postgraduate training programmes.