James A. Halsted

Syndrome of iron deficiency anemia, hepatosplenomegaly, hypogonadism, dwarfism and geophagia☆

Abstract A syndrome occurring in males, characterized by severe iron deficiency anemia, hypogonadism, dwarfism, hepatosplenomegaly and geophagia, has been observed in villagers in Iran suffering from malnutrition. Eleven such patients, studied in detail, are described. Despite hepatosplenomegaly, results of the liver function tests were uniformly normal except for the serum alkaline phosphatase, which was consistently elevated. The anemia was not associated with blood loss, hookworm infestation or intestinal malabsorption, and responded promptly to oral iron therapy. Although the diet contained adequate amounts of iron it is believed that the predominantly wheat diet, with its high phosphate content, interfered with absorption because of the formation of insoluble iron complexes. Correction of the anemia resulted in marked decrease in the size of the liver and spleen. Prolonged follow-up of patients receiving a well balanced diet indicates that the endocrine abnormalities of growth and sexual development are reversible. The relationship of geophagia (which occurred in nearly all patients) to this syndrome is not clear, and is discussed. The possibility of zinc deficiency is considered as an explanation of hypogonadism, dwarfism and changes in alkaline phosphatase.

Absorption of radioactive vitamin B12 in the syndrome of megaloblastic anemia associated with intestinal stricture or anastomosis

Abstract 1.1. The literature concerned with the subject of megaloblastic anemia occurring in certain individuals with intestinal lesions is reviewed, and two additional cases of this syndrome are reported. 2.2. The pathogenesis of the anemia is discussed. Factors favoring the development of an abnormal bacterial flora in the small intestine are a common denominator of the syndrome. Among such factors are an intestinal stricture or an anastomosis, resulting in intestinal stasis. Gastrocolic fistula also appears to result in bacterial contamination of the small intestine, and may be associated with macrocytic anemia. 3.3. The absorption of radioactive vitamin B 12 was determined in the two cases which are reported and was found to be significantly impaired in each. Administration of intrinsic factor had no effect but the administration of aureomycin or achromycin resulted in markedly increased absorption. However, there was no increase when neomycin was given. 4.4. These studies provide additional support for the concept that abnormal bacterial growth in the small intestine may result in impaired utilization of vitamin B 12 , with the development of megaloblastic anemia in some instances. 5.5. The exact mechanism whereby intestinal bacteria may affect hematopoiesis adversely, and certain antibiotics may favorably influence it, is not yet clear.

Plasma Zinc Concentration in Liver Diseases:Comparison with normal controls and certain other chronic diseases

Summary Plasma zinc was determined by atomic absorption spectrophotometry in 54 patients with various types of liver disease and 20 patients with chronic debilitating disease but with normal liver function. The results were compared with those in 51 control subjects. In alcoholic and postnecrotic cirrhosis

Mechanisms involved in the development of vitamin B12 deficiency.

Summary The use of radioactive (cobalt 60 -labeled) vitamin B 12 constitutes a new method for studying intestinal absorption of vitamin B 12 . This tool has been useful in elucidating mechanisms involved in the development of vitamin B 12 deficiency. Four distinct mechanisms can be identified. These are: a) deficiency of intrinsic factor, b) bacterial or parasitic interference with normal absorption of vitamin B 12 , c) defective absorptive capacity of the intestinal mucosa, and d) inadequate dietary intake of vitamin B 12 The pathologic physiology involved in each of these categories is discussed, and illustrative cases are presented.

Zinc Deficiency in Guinea Pigs

Summary This study has demonstrated that the guinea pig does require zinc. The animals fed a zinc deficient diet (1.2 ± 0.4 ppm) had a significant (p < 0.001) decrease in the plasma and femur zinc concentration compared with those guinea pigs fed a diet containing 104 ± 8.4 ppm zinc. The quantitative requirement of zinc for the guinea pig has not been determined in this study. A possible use of the guinea pig in a study to investigate the relationship between zinc and ascorbic acid is discussed.

Effect of oral contraceptive hormones on zinc metabolism in the rat.

Summary The effects of an estrogen (mestranol), a progestational agent (norethindrone), and a combination of the two hormones on plasma zinc concentration, growth, and zinc-65 uptake in selected tissues were investigated in female rats fed a zinc-sufficient diet. Mestranol significantly (p<0.02) lowered plasma zinc concentration whereas norethindrone had no effect. Mestranol caused a significant increase in the uptake of a single injected dose of zinc-65 in the liver, spleen, adrenals, and uterus. Mestranol also caused a significant decrease in the growth.

Aspects of medical education in Iran.

THE Journal recently published a Special Article on health problems of the Middle East in which a brief historical sketch of the whole area was presented.1 Iran, or Persia,† is part of the Middle E...