Impaired vitamin B-12 and folate absorption as a risk factor for hyperhomocysteinemia in ileal neobladder

The terminal ileum is widely used for reconstruction of the lower urinary tract since the terminal ileum exclusively absorbs vitamin B-12, removal of ileum from the gastrointestinal tract for lower urinary tract reconstruction may predispose patients to vitamin B-12 deficiency. The purpose of this study is to evaluate the long term metabolic and nutritional effects of incorporating intestinal segments in urinary tract on the levels of vitamin B-12 and/or folic acid and their relation with the level of total homocysteine in patients suffering from bladder cancer. This study included twenty seven patients suffering from bladder cancer, with mean age 45 +/- 8.34 years. Twenty one healthy subjects were included in this study to serve as control. The levels of serum vitamin B-12, folic acid and total homocysteine [T-Hcy,] were estimated. Serum T-Hcy level was significantly elevated in pre- and Postoperative patients suffering from bladder cancer when compared to control. The levels of serum vitamin B-12 and folic acid were significantly reduced the drop was markedly increase during 5 months to two years. In conclusion, patients with terminal ileal neobladder reconstruction [5 months - 2 years] of the urinary tract had deficiency of vitamin B-12 and folic acid. Also those patients had hyperhomocysteinemia due to this deficiency. Life long surveillance of vitamin B-12 level annually, that a modest supplement be sampled before twice yearly [by injection may be beneficial and that serum vitamin B-12 must he giving vitamin B-12 injection to avoid cardiovascular disease complication

Anemia megaloblástica y manifestaciones gastrointestinales en Lima: ¿La punta del iceberg? / Megaloblastic anemia and gastrointestinal aspects in Lima: The tip of the iceberg?

Se revisa la casuística, de los tres últimos años, del servicio de Hematología y de un total de 316 casos se escogieron veinte que reúnen los criterios de inclusión (6.23%). Resultados: palidez y malestar en el 100%, alteraciones en el ritmo defecatorio 75%, náusea, vómito y sangrado en 40%, ictericia 25%, asco por los alimentos 20%, infección 10%. Anemia severa hiporregenerativa en el 100%, trombocitopenia 75% pancitopenia 60% como procesos asociados encontramos: antecedentes gineco-obstétricos en el 25%, tuberculosis entero-peritoneal 15%, y sin causa aparante el 40% primaria. En once pacientes se hicieron dosaje de Vitamina B12 y ácido fólico, encontrándose: déficit de B12 en 6 (54.5%), de ácido fólico en 3 (27.2%) y de ambos en dos (118.1%). Salvo un paciente que falleció en sepsis, los restantes respondieron adecuadamente al tratamiento vitamínico. Encontramos que la deficiencia de ácido fólico asociada a ferropenia, predominó en pacientes con antecedentes obstétricos; el déficit combinado, en aquellos con patología asociada y la falta de B12 en el grupo sin causa aparente. De la información nacional disponible y nuestra observaciones, podemos concluir que estamos frente a un brote de anemia megaloblástica que cursa frecuentemente con manifestaciones gastrointestinales y cuya causa aún no ha sido esclarecida