Is it worth doing barium enemas on patients with unexplained iron deficiency anaemia?

The incidence on double contrast barium enema (DCBE) of carcinomas and polyps > 1 cm in size was compared in 92 patients with iron deficiency anaemia and a group of randomly obtained non-anaemic controls. In the anaemic group there were eight carcinomas and four polyps, and in the control group two carcinomas and no polyps. The incidence of neoplasms in the anaemic group (13.0%) was significantly greater than in the control group (1.6%). The incidence of neoplasms in iron-deficient males was 19% compared with 9% in females. The presence of bowel symptoms or weight loss were not found to be significant. This study confirms the value of DCBE in investigating patients with unexplained iron deficiency anaemia even in the absence of bowel symptoms.

Intestinal neurofibromatosis in von Recklinghausen's disease: presenting as chronic anemia due to recurrent intestinal hemorrhage.

Neurofibromatosis (von Recklinghausen's disease) is a neuroectodermal disorder characterized by pigmentary changes of the skin (café-au-lait spots), cutaneous and visceral tumors (neurofibromas) and systemic abnormalities. The involvement of gastrointestinal tract in neurofibromatosis is not common. The most common symptoms, refer able to lesions in the gut, are hematemesis, melena and abdominal pain. We experienced a case of intestinal neurofibroma in von Recklinghausen's disease. The patient was a 39 year-old female who had suffered from chronic iron deficiency anemia and recurrent gastrointestinal hemorrhage due to two neurofibromas of jejunum for 3 years, which was diagnosed by superior mesenteric and ileal arteriogram and 99mTc pertechnetate-labelled RBC scan, and treated by segmental resection of jejunum with end to end anastomosis.

[Changes in heart volume in patients with iron-deficiency anemia (based on data from teleroentgenocardiography)]. / Izmeneniia ob''ema serdtsa u bol'nykh zhelezodefitsitnoi anemiei (po dannym telerentgenokardiografii).

Teleroentgenocardiography was employed in 96 patients with iron deficiency anemia with the purpose of evaluating the cardiac volume. This volume increased with advance of the disease. The number of women with cardiomegaly increased as well. Cardiomegaly showed a tendency to normalization in the course of treatment. These findings are of importance for the treatment and rehabilitation of patients with iron deficiency anemia.

[Scintigraphic detection of gastrointestinal hemorrhage. Value and limitations]. / Localisation scintigraphique des saignements digestifs. Intérêts et limites.

A technetium-99m labelled red blood cell scintigraphy was performed in 51 patients with an unexplained gastro intestinal bleeding. Static images were acquired on the injection day then at 24 hours. Forty one patients had a positive scintigraphy. In 13 patients with a positive scintigraphy, on the injection day (5 cases) and later (8 cases), no intestinal bleeding was identified in spite of further investigations guided by scintigraphy. In 24 patients, with a positive scintigraphy on the injection day (20 cases) and later (4 cases), an intestinal lesion was identified and treated; data were confirmed in 19 cases: there were 15 colon lesions, localized on caecum in 10 cases and 4 small bowel lesions. Clinical value and limitations of the investigation are discussed. The scintigraphic localization is usually accurate if the abnormal focus activity is noticed on the injection day. It helps to guide further investigations of the bleeding site. This non invasive method should be performed more quickly to help to localize intestinal bleeding which poses a diagnostic problem.

The potential pitfall of attributing iron deficiency anaemia to ulceration in a Barrett's oesophagus.

We report a 58-year-old man with recurrent ulceration in a Barrett's oesophagus whose iron-deficiency anaemia was in fact due to a caecal carcinoma. Recent reports suggest an association between these two disorders. A Barrett's oesophagus should not be blamed for iron deficiency unless neoplasms of the colon have been excluded.

[Determination of length, width and height of the human skull by critical use of roentgenologic craniometry methods]. / Zur Bestimmung von Länge, Breite und Höhe des menschlichen Schädels unter kritischer Anwendung der Methoden der röntgenologischen Kraniometrie.

X-ray craniometry has gained in importance for scientific and clinical examination. It enables accurate measurement of shape and structure of the human skull, its characterisation and an accurate description of the type and cause of changes of its shape and components. Roentgenological craniometry is closely related to craniometry of anatomists and anthropologists, but in a few essential points it does differ from it--rather fundamentally, in fact. On using the roentgenological method, the general laws of x-ray imaging must be strictly observed and measurements must be effected only if they are conducted from such points which are roentgenologically clearly defined. Measurements must be definite, repeatable at any time and suitable for comparative purposes. The influence exercised by these conditions becomes noticeable already on determining the three principal dimensions of the cranium. Whereas the x-ray determination of the length and breadth of the cranium is easy to perform and does not present any problem, determination of the "height" of the cranium causes considerable difficulties that are mainly based on the statement of suitable points of measurement. Detailed studies and deliberations have shown that the distance between the vault and the base of the skull can supply a suitable measure for assessing the height of the skull. On lateral x-ray film the distance between the "endobregma" and the "bony floor of the hypophyseal cavity" is a suitable criterion, whereas on the sagittal x-ray films of the skull the criterion is the distance between "bregma" and "hypophyseal basis". The "lateral hypophyseal height of the skull" and the "sagittal hypophyseal height" are largely equal, clearly defined and always repeatable.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative evaluation of bile diversion surgery utilizing 99mTc HIDA scintigraphy.

This is a report of 21 patients presenting with epigastric pain, bilious vomiting, upper gastrointestinal bleeding, iron-deficiency anemia, and weight loss, who had undergone Billroth II gastrectomy from 3 to 35 yr earlier. Eighteen of 21 patients were found to have significant enterogastric reflux indices varying from 60% to 95% demonstrated by 99mTc HIDA scintigraphy. Thirteen patients had diversion antireflux surgery in the form of a Roux-en-Y procedure, and 1 patient had a Henley loop jejunal interposition. Postoperative 99mTc HIDA scintigraphic studies showed the enterogastric reflux indices to have decreased significantly to a range of 2%-26% (p less than 0.00001). There was marked improvement of symptoms, including correction of anemia and weight gain in those patients who had been anemic or who had sustained earlier weight loss. The enterogastric reflux indices of 10 asymptomatic control patients after Billroth II gastrectomy ranged from 4% to 45%. 99mTc HIDA scintigraphy is useful in evaluating patients before and after bile diversion surgery, and demonstrates the quantitative decrease in enterogastric reflux after such surgery.

Relevance of the barium follow-through examination in the diagnosis of adult celiac disease.

Significant changes on a standard barium follow-through examination in celiac disease have been determined by comparison with functional changes (irritable bowel syndrome), malabsorption without a villous lesion (chronic pancreatitis), and a villous abnormality without malabsorption (dermatitis herpetiformis). Patients with iron deficiency anemia formed the control group. Slight jejunal dilatation (26-30 mm) was found in 15% of the celiacs and 17% of the irritable bowel patients. Dilatation in excess of 30 mm and/or effacement of jejunal fold pattern occurred only with an abnormal jejunal biopsy, in 54% of the celiacs and 33% of the dermatitis herpetiformis patients. Patients with malabsorption by itself and 46% of the celiacs could not be distinguished from those with irritable bowel syndrome. The concept of a malabsorption pattern is considered invalid, and the diagnosis of celiac disease can be reliably established only by peroral jejunal biopsy.

[Double contours and companion shadows in the skull associated with anaemias (author's transl)]. / Doppelkonturen und Begletischatten am Schädel bei anämischen Erkrankungen.

Lateral X-ray pictures of the skull in certain several and chronic disorders of the blood as thalassaemia, congenital haemolytic anaemia, sickle cell anaemia and iron deficiency disease show frequently changes of the outlines of the cranial bones. They consist of a double contour of the outer cranial border and on the interior side below the sagittal sutura of a band-like shadow or of multiple stripes and lines running parallel to the carnial vault. They concern the parietal bones and may extend from the bregma till to the lamda or occupy only a part of this distance. The roentgenological features are due to the enlargement of the crainal bones, the bulging out of both parietal bondes, the sometimes enlarged and deepened borders of the sulcus sagittalis superior and particularly to the furrow and depression on the skull above the sagittal suture caused by the protruding parietal bones on both sides. As these different abnormal structures must be passed by the picturing X-ray, effects of superposition and interference are produced. Longitudinal ridges or bony edges which could explain the roentgenological findings could not be established. Since the peculiar alterations of the cranial bones are mainly found in the mentioned blood disorders, where they are caused by the overgrowing red marrow, they also display the same roentgenological features. These features are, therefore, a characteristic sign of these diseases.

[X-Ray and clinical study of the nose, sinuses and maxilla in patients with severe iron deficiency disease (author's transl)]. / Röntgenologische und klinische Untersuchung der Nase, der Nasennebenhöhlen und des Oberkieferknochens bei Patienten mit schwerer Eisenmangelkrankheit

A definite relation between ozaena and iron deficiency disease could not be verified. However, the examination of 88 patients with severe iron deficiency disease, mostly of juvenile age, revealed that X-ray pictures of the nose and the paranasal sinuses showed abnormal alterations indicating the existence of a non-inflammatory process. There were few symptoms from the nose and the neighbouring structures as well as insignificant clinical findings by inspection of these structures. The increased opacity of the maxillary sinuses on the roentgenograms and some other changes are considered to be partially due to the insufficient pneumatisation which is related to the retarded development and maturation of juvenile patients with iron deficiency disease. Furthermore, it is caused by the enlargement and thickening of the facial bones resulting from the expansive growth of the hyperplastic and hypertrophic red marrow filling completely the cancelous substance. The space of the maxillary sinuses is narrowed in many cases, the penetration power of the X-ray diminished and the clearing effect of the air containing cavities decreased.