Longitudinal study of Chinese patients with pernicious anaemia.

BACKGROUND: The survival of whites who have been treated for pernicious anaemia (PA) is unaffected, apart from incurring a greater risk of gastric cancers. The long term outcome of PA in Chinese is unknown. METHODS: A hospital based prospective longitudinal study of Chinese PA patients was conducted. Patients with known cancers were excluded. RESULTS: From 1994 to 2007, 199 intrinsic factor antibody (IFA) positive and 168 IFA negative patients were recruited. Both cohorts had similar baseline characteristics, except the IFA positive patients had more severe haematological findings and more thyrogastric immune features; also more IFA negative patients had type 2 diabetes mellitus and gastrointestinal (GI) disease or GI surgery. Both cohorts had a good haematological response but an unsatisfactory neurological response to treatment. Hypothyroidism developed in patients of both cohorts during follow-up. 24 IFA positive patients and 7 IFA negative patients developed cancers (p = 0.007) during follow-up. 20% of all cancers were gastric carcinoma. Mean survival of both cohorts was similar. Mean survival of IFA positive patients with and without cancers was 64 and 129 months, respectively (p<0.001), and that of IFA negative patients 36 and 126 months, respectively (p<0.001). Death rates were 31% in the IFA positive cohort and 21% in the IFA negative cohort (p = 0.028). Cancer related death rates of IFA positive and IFA negative cohorts were 37% and 14%, respectively (p = 0.014). CONCLUSION: The survival period of Chinese with PA who have received treatment is good, but there is an increased risk of gastric cancers. IFA positive patients have a higher risk of developing all types of cancers and cancer related deaths than IFA negative patients.

La voluntad de morir / The death wish

En la carta del 19 de febrero de 1923, Ferenczi da cuenta a Groddeck de la muerte de una paciente suya por anemia perniciosa. De esa misma enfermedad moriría 10 años después el mismo Ferenczi. En esos 10 años su contribución teórico clínica fue extraordinaria y atravesó momentos cruciales del desarrollo de la teoría psicoanalítica como la conceptualización de Freud sobre la pulsión de muerte, la configuración de la segunda tópica, la publicación de Thalassa y "el principio de afirmación del displacer", la segunda teoría de Freud sobre la angustia y un intercambio epistolar con Groddeck que permite percibir los primeros esbozos de una teoría sobre la sintomatología psicosomática que sería posteriormente desarrollada. El autor intenta establecer las conexiones teóricas entre todos estos argumentos, destacando la aportación genial de Ferenczi que se nutría en muchos momentos de su propia experiencia patológica y de su propio sufrimiento interno. Una de las obras en las que con mayor claridad se refleja esta cuestión, es en su trabajo sobre "El niño mal recibido y la pulsión de muerte", donde aparece claramente conceptualizada la voluntad de morir, a la que se refiere todo este trabajo (AU)

In a letter of the 19th of February, 1923, Ferenczi tells Groddeck about the death of a patient of his by progressive pernicious anaemia. Ferenczi would die of that same illness ten years later. In those ten years his theoretical-clinical contribution was extraordinary, and went through crucial moments of the development of psychoanalytical theory such as Freud´s death drive, the configuration of the second topic, the publication of Thalassa and the problem of the acceptance of unpleasant ideas, Freud´s second theory of anxiety, and a correspondence with Groddeck that allows us to perceive the first outline of a theory on psycosomatic symptomatolgy that would be developed later. The author endeavours to establish some theoretical connections between these two arguments, highlighting Ferenczi´s brilliant contribution, which was often fueled by his own pathological experience and inner suffering. One of the works in which this matter is treated with great clarity is The Unwelcome Child and his Death Drive, in which the death wish, to which I will refer to throghout this work, is clearly conceptualized (AU)

Pernicious anaemia in the textile industry.

The objective was to examine whether the observed excess mortality from anaemia in textile and clothing workers was associated with any specific anaemia type or occupational activity. The design was a death certificate based case-control study of textile and clothing workers who died in England and Wales in the years surrounding the decennial censuses of 1961, 1971, and 1981. The main outcome measures were type of anaemia, place of residence, place of birth, and occupation. The frequency of the different types of anaemia in textile and clothing workers differed from that of England and Wales with relatively more deaths from pernicious anaemia than in the country as a whole (74 observed v 55 expected deaths). Within the industry, those whose death was attributed to pernicious anaemia were more than twice as likely as other textile and clothing workers to have worked in textile mills (odds ratio = 2.4, 95% confidence interval 1.4-4.2). These results could not be explained by age, sex, place of residence, or place of birth, and review of the death certificates did not suggest that pernicious anaemia as a cause of death had been recorded in error. Historical support for the finding was found in the Registrar General's 1931 decennial supplement on occupational mortality, in which the standardised mortality ratio from pernicious anaemia in male textile mill workers was estimated to be twice that of the general population. In conclusion, occupational factors, specifically work in textile mills, could be implicated in the pathogenesis of pernicious anaemia. The aetiology of this disease is not well understood and further study of pernicious anaemia in textile mill workers is required.

[Long-term follow up of patients with pernicious anemia]. / Anaemia perniciosás betegek hosszan tartó megfigyelésével szerzett tapasztalataink.

The authors give several data of 357 patients with megaloblastic anaemia diagnosed, treated and controlled between 1958-1988. 334 of the patients had anaemia perniciosa and 23 of them had postresectional megaloblastic anaemia. After listing the criteria of the diagnosis the authors detail the mean age of the patients at the time of diagnosis, the distribution of sexes, age and blood groups among the patients, the number of new cases per year, the frequency of relapsus of the disease and its association with other autoimmune diseases. They also deal with the characteristic seasonal fluctuation and the accumulated cases in families. Its association with malignant tumours, especially with stomach carcinoma was examined.

Treatment of severe pernicious anemia: no association with sudden death.

An increased risk of early, sudden death after treatment of megaloblastic anemia has been reported. This was particularly true for severe anemia, with a mortality rate of 14%. Because no other investigations of this phenomenon have been done since these alarming findings, the experience at our medical center was reviewed. Of 219 patients with pernicious anemia, 101 had severe anemia (hemoglobin less than or equal to 80 g/L). None of the severely anemic patients died during hospitalization. Only one death occurred among all 219 patients and this death was not unexpected but attributable to coexisting diseases. Pernicious anemia, even when severe, is not associated with increased mortality after therapy.

[Late fate of patients with pernicious anemia]. / Spätschicksale von Perniziosakranken

In a retrospective study is reported on 271 cases of pernicious anaemia which were observed for 30 years. 2 groups of patients could be significantly differed. In the first group the disease appears familiarly and/or is combined with a diabetes mellitus or a disease of the thyroid gland. Its manifestation is 7 years earlier than in the 2nd group, in individual cases without genetic relation. In this a heterologous etiology of the pernicious anaemia is to be seen. On principle in therapy was treated only parenterally and relatively small quantities of vitamin B12 were given. In these cases the results were good. Recidivations appeared only quite infrequently. The life expectancy obtained is altogether high, but it is, however, somewhat under the average of a healthy population of the same age. Despite careful control and early operation the gastric carcinoma more frequently appeared as cause of death than in the average population of the same age, whereas all other tumours were more rarely found.