[Should we use oral replacement for vitamin B12 deficiency as the first option of treatment?]. / 'Debemos utilizar la vía oral como primera opción para el tratamiento del déficit de vitamina B12?

OBJECTIVE: Analyze whether the tablets available in Spain are useful for oral replacement in the treatment of vitamin B12 deficiency. METHODS: From June 2003 to December 2005, patients with vitamin B12 deficiency attended at the Internal Medicine Clinic, were offered the possibility of starting or switching to oral therapy. Clinical and biochemical responses were monitored at baseline and at 2, 4, 6, 12, 18 y 24 months of follow-up. RESULTS: Twenty-eight patients were included (55.6% women), with a mean age of 74.96 +/- 9.98 years. Twenty-three cases (82.1%) had pernicious anemia, and 5 were gastrectomized. Patients who switched from intramuscular to oral therapy (16 cases) showed no decrease in the mean values of hemoglobin and B12 levels during the follow-up. Patients who started on oral therapy showed an increase in the values of hemoglobin (from 9.9 +/- 2.8 g/dl to 13.5 +/- 1.1, p = 0.003) and vitamin B12 (from 118 +/- 50 pg/ml to 496 +/- 229, p = 0.001) as early as two months after baseline, maintaining the response during the follow-up. No patient refused oral therapy and no toxic effect attributed to oral therapy was recorded. CONCLUSIONS: Oral replacement of vitamin B12 deficiency with the tablets available in Spain is safe, effective and acceptable to patients.

¿Debemos utilizar la vía oral como primera opción para el tratamiento del déficit de vitamina B12? / Should we use oral replacement for vitamin B12deficiency as the first option of treatment?

Objetivo. Analizar la utilidad de los preparados comerciales disponibles en nuestro país para el tratamiento del déficit de vitamina B12 por vía oral. Método. Desde junio de 2003 a diciembre de 2005 se ofreció a los pacientes con déficit de vitamina B12 diagnosticados o en seguimiento en una consulta externa de Medicina Interna el inicio del tratamiento por vía oral o el cambio de la vía intramuscular por la oral. Se realizaron controles clínicos y analíticos al inicio del tratamiento oral y a los 2, 4, 6, 12, 18 y 24 meses de seguimiento. Resultados. Se incluyeron en el estudio 28 enfermos (55,6% mujeres), con una edad media de 74,96 ± 9,98 años. Veintitrés casos (82,1%) presentaban anemia perniciosa y 5 estaban gastrectomizados. En los pacientes que recibían tratamiento intramuscular (16 casos) no se observaron diferencias en los valores medios de hemoglobina y vitamina B12 tras cambiar a vía oral. Los enfermos que iniciaron tratamiento directamente por vía oral presentaron ya a los dos meses un ascenso de los valores de hemoglobina (de 9,9 ± 2,8 g/dl a 13,5 ± 1,1, p = 0,003) y vitamina B12 (de 118 ± 50 pg/ml a 496 ± 229, p = 0,001). Estas diferencias se mantuvieron a lo largo de todo el período de seguimiento. Ningún paciente abandonó el tratamiento oral y no se registraron efectos secundarios atribuibles al mismo. Conclusión. La efectividad, seguridad y tolerancia del tratamiento por vía oral del déficit de vitamina B12 con los preparados comerciales disponibles en España son excelentes (AU)

Objective. Analyze whether the tablets available in Spain are useful for oral replacement in the treatment of vitamin B12 deficiency. Methods. From June 2003 to December 2005, patients with vitamin B12 deficiency attended at the Internal Medicine Clinic, were offered the possibility of starting or switching to oral therapy. Clinical and biochemical responses were monitored at baseline and at 2, 4, 6, 12, 18 y 24 months of follow-up. Results. Twenty-eight patients were included (55.6% women), with a mean age of 74.96 ± 9.98 years. Twenty-three cases (82.1%) had pernicious anemia, and 5 were gastrectomized. Patients who switched from intramuscular to oral therapy (16 cases) showed no decrease in the mean values of hemoglobin and B12 levels during the follow-up. Patients who started on oral therapy showed an increase in the values of hemoglobin (from 9.9 ± 2.8 g/dl to 13.5 ± 1.1, p = 0.003) and vitamin B12 (from 118 ± 50 pg/ml to 496 ± 229, p = 0.001) as early as two months after baseline, maintaining the response during the follow-up. No patient refused oral therapy and no toxic effect attributed to oral therapy was recorded. Conclusions. Oral replacement of vitamin B12 deficiency with the tablets available in Spain is safe, effective and acceptable to patients (AU)

Afectación aislada del nervio hipogloso y disección carotídea recurrente / Isolated disorder of the hypoglossal nerve and recurring carotid dissection

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E-selectin polymorphism in erythema nodosum secondary to sarcoidosis.

OBJECTIVE: E-selectin is expressed on cytokine-stimulated endothelial cells and plays an important role in leukocyte-endothelium interactions and inflammatory cell recruitment. An A/C polymorphism at position +561 in the E-selectin gene, which yields an amino acid exchange from serine to arginine at position 128 in the epidermal growth factor-like domain, has been described. We have assessed whether this bi-allelic polymorphism may be implicated in the clinical expression of erythema nodosum (EN) secondary to sarcoidosis. METHODS: Thirty-one patients with biopsy-proven erythema nodosum (EN) associated with sarcoidosis, 68 patients with biopsy-proven EN related to other etiologies and 66 healthy matched controls from the Lugo region of Northwest Spain were studied. Patients and controls were genotyped for the A/C polymorphism gene by PCR-restriction fragment length polymorphism. RESULTS: A significantly reduced frequency of the C mutant allele was observed in patients with EN secondary to sarcoidosis compared to controls (p = 0.019) and also compared to patients with EN unrelated to sarcoidosis (p = 0.028). This was also the case when the distribution of genotypes in patients with sarcoidosis was compared with that observed in patients with EN due to other etiologies (p = 0.028) and controls (p = 0.037). This was due to an absence in both C/A heterozygotes and C/C homozygotes in patients with EN secondary to sarcoidosis. CONCLUSIONS: The present study constitutes the first attempt to assess the influence of E-selectin polymorphism at position +561 in the development of sarcoidosis. The C allele at the +561 position of the E-selectin gene is associated with significantly reduced risk of developing sarcoidosis in patients with EN.