Alfred Doscherholmen

Impaired Assimilation of EGG CO57 Vitamin B12 in Patients With Hypochlorhydria and Achlorhydria and After Gastric Resection

Abstract Patients who have undergone gastric resection and those with simple gastric hypochlorhydria and achlorhydria may have low serum B 12 concentrations with normal absorption of radiocyanocobalamin. Impaired assimilation of food vitamin B 12 , but not of the crystalline Co 57 B 12 , may be the cause for this phenomenon. This hypothesis was tested by comparing the assimilation of Co 57 B 12 incorporated into eggs in vivo with that of crystalline Co 57 B 12 . As judged by the urinary excretion test, 10 patients with gastric resection having low serum B 12 , values and normal absorption of crystalline B 12 , absorbed on the average 9% of that observed in 11 normal control subjects when the egg Co 57 B 12 was administered. Similarly, 5 patients with achlorhydria or severe hypochlorhydria absorbed on the average 12% of that seen in normal subjects. There was no difference in the absorption of the crystalline Co 57 B 12 in these groups. An equally poor assimilation of nonlabeled food B 12 may explain the low serum B 12 concentrations found in postgastrectomy patients, and achlorhydric subjects with low serum B 12 and normal absorption of crystalline radiocyanocobalamin. Patients with pernicious anemia and those with gastric resection showing low serum B 12 concentrations and B 12 absorption values had extremely poor assimilation of both food Co 57 B 12 and crystalline Co 57 B 12 .

Inhibitory effect of eggs on vitamin B12 absorption: description of a simple ovalbumin 57Co-vitamin B12 absorption test.

Summary. Ovalbumin and egg yolks, mixed separately in vitro with radiocyanocobalamin (57Co‐vitamin B12), were served to normal volunteers in a cooked form. Ovalbumin, and to a lesser degree, egg yolks were observed to inhibit vitamin B12 absorption. This observation explains the rather poor assimilation of vitamin B12 from eggs labelled in vivo with 57Co‐vitamin B12.

Chronic myelogenous leukemia in Hodgkin's disease: Immunofluorescence of cells

A patient with Hodgkins disease is described who developed chronic myelogenous leukemia 8 1/2 years after the start of radiation therapy. This therapy was fractional and was administered to most of the patients skeleton. The radiation was an important factor in the development of leukemia. The presence of positive reactions to the antileukemic fluorescent antibodies may be consistent with the hypothesis that viruses are concerned with human leukemia.

Influence of Age and Stomach Function on Serum Vitamin B12 Concentration

Serum vitamin B12 (B12), maximal gastric acid output (MAO), and B12 absorption were determined in 82 subjects, age 32 to 85 years, who had normal absorption of radiocyanocobalamin. In 46 of the patients the gastric intrinsic factor (IF) was also measured. Serum B12 concentration and MAO varied widely in all age groups from abnormally low to definitely normal. The mean values for serum B12 and MAO, however, declined very similarly with advancing age owing to an increased incidence of low values for these two measurerment in the aged. There was no significant fall in the mean B12 absorption or IF secretion as a function of old age. Achlorhydric and hypochlorhydric patients invariably had lower mean serum B12 concentrations than those with adequate MAO. Conversely, patients with normal MAO all had normal serum B12 levels. Serum B12 concentration, although correlating with both MAO and IF secretion, showed a closer relationship to the former than to the latter. These findings suggest that the stomach, aside from producing the IF, plays an important role in maintaining a normal serum B12 concentration.

Alteration of Hepatic Storage of Radiolabeled Vit. B12.

Summary Radioactivity measurements were made over the liver, spleen and precordium for 7 1/2 months after oral administration of test doses of radioactive vit. B12. One subject was given a large series of parenteral injections of nonradioactive vit. B12, while another subject served as a control. The disappearance rate of radioactivity was much faster with the repeated parenteral injections. Radioactivity was lost in the urine. These observations showed that massive parenteral doses of vit. B12 exchanged with cyanocobalamin stored in the liver.

Hematologic alterations following partial gastrectomy

Serum and red blood cell (RBC) levels of vitamin B12 and folic acid together with serum iron and total iron binding capacity were followed in 142 patients with partial gastrectomy. Follow-up period was from two months to 25 years after surgery. Anemia was the primary hematologic alteration documented as a complication of surgery. Of the parameters followed, RBC depletion of vitamin B12 occurred before a significant decrease in circulating serum values. We believe we are the first to report on the separation of RBC depletion of vitamin B12 and folic acid in the presence of iron deficiency.

Aberrant human gastric response to secretin.

The effect of histamine and secretin infusions on gastric secretory volume and acid production has been studied in 22 patients with peptic ulcer disease and one normal volunteer. Some of these patients had normal mucosa; some had gastric mucosal hypertrophy and/or antritis. During histamine infusion the mean pH was 1.14 and the mean secretory volume was 351 cc/hr. With histamine-secretin infusion these values rose to 3.51 and 584 cc/hr, respectively. Duodenal regurgitation was excluded by appropriate studies in seven studies. Patients infused with histamine alone for four hours showed no change in pH or secretory volume. Five patients had secretin infusion only. During the basal period their mean pH was 4.24 and mean secretory volume 101.2 cc/hr. During the period of secretin infusion these values rose to 8.14 and 278.6 cc/hr, respectively. Statistical analysis of these findings suggests that the production of an alkaline fluid during the secretin infusion is related to antritis. These findings differ from previous studies in which secretin was given either alone or in combination with histamine infusion. The clinical or pathological significance of these observations is discussed.