ABSTRACT
Our case-report presents a 62 year old woman with spontaneous onset of a distinct walking disorder and pancytopenia. The diagnosis showed a sub-acute combined degeneration of the spinal cord (SACD) and a megaloblastic anemia as a result of a cobalamin deficiency. This was caused by a strict vegetarian nutrition since 18 years. Once on therapy with cobalamin substitutes the clinical and laboratory test results improved within 3 months.
Subject(s)
Anemia, Megaloblastic/etiology , Demyelinating Diseases/diagnosis , Diet, Vegetarian/adverse effects , Gait Disorders, Neurologic/etiology , Pancytopenia/etiology , Vitamin B 12 Deficiency/diagnosis , Anemia, Megaloblastic/diagnosis , Biopsy , Bone Marrow/pathology , Demyelinating Diseases/etiology , Female , Gait Disorders, Neurologic/diagnosis , Humans , Middle Aged , Pancytopenia/diagnosisABSTRACT
AIM OF THE STUDY: To determine the heat transfer by circulating-water mattresses placed under the back and over both legs of human volunteers. METHODS: With approval by the local ethics committee and informed consent eight minimally clothed volunteers were included in the study. Six calibrated heat flux transducers were placed on the back and additionally eight sensors were placed on both legs of each volunteer. The volunteers reclined on a circulating-water mattress (ComfortPad Plus(R), Cincinnati Sub-Zero Products Inc., Cincinnati, OH, USA) coated with gel (Granulab International, Armersfoort, Niederlande). Another circulating-water mattress (Plastipad trade mark, Cincinnati Sub-Zero Products Inc.) was placed over both legs. Both devices were heated to 41 degrees C by a hypo-hyperthermia system (Hico-Variotherm 530, Hirtz and Co. Hospitalwerk, Cologne, Germany). Heat flux data were sampled during steady-state conditions. After determination of the contact area between the mattresses and the skin, heat transfer was calculated by multiplication of the heat flux per area by the contact area. RESULTS: Heat flux per area to the back was 45.6 +/- 4.5 W m (- 2), the contact area was 0.39 +/- 0.03 m (2). This resulted in a heat transfer of 18.0 +/- 2.4 W. Heat flux per area to the legs was 24.7 +/- 4.3 W m (- 2), the contact area was 0.12 +/- 0.01 m (2). This resulted in a heat transfer of 2.9 +/- 0.6 W. CONCLUSION: The heat transfer of the circulating-water mattress to the back was much higher than the heat transfer to the legs. Nevertheless, model calculations show that conductive warming of the legs is more important for the prevention of perioperative hypothermia than conductive warming of the back, because it has a higher impact on the heat balance.
