RESUMO
INTRODUCTION: Cobalamin deficiency is frequent in elderly patients and the main aetiologies are food-cobalamin malabsorption and pernicious anaemia. The aim of our retrospective study was to identify the causes and methods of management of cobalamin deficiency at Nice geriatric university hospital. METHODS: A retrospective monocentric study was conducted over 14 months at Nice geriatric hospital, which included patients with cobalamin deficiency having received supplementation. The clinical and paraclinical data, etiological diagnosis, treatment and follow-up modalities were analyzed retrospectively. RESULTS: We studied 125 elderly patients whose median age was 85.5 ± 7 years. The etiological diagnosis was food-cobalamin malabsorption for 72 patients (57.6 %), nutritional cobalamin deficiency for 15 patients (12 %), pernicious anaemia for 12 patients (9.6 %) and there was no etiological diagnosis for 26 patients (20.8 %). Concerning cobalamin therapy, 111 patients (88.8 %) received oral therapy and 14 (11.2 %) intramuscular therapy. Vitamin B12 levels increased significantly after supplementation (p<0.001) but cobalamin administration varied according to the diagnoses (p<0.001) and was less effective in patients with dementia (p=0.04) and food-cobalamin malabsorption. CONCLUSION: Our study showed the importance of food-cobalamin malabsorption in etiological diagnosis in accordance with the literature, but also the non-negligible share of nutritional cobalamin deficiency. Mainly oral cobalamin supplementation was used in our study with a significant increase in vitamin B12 levels. An oral cobalamin regimen is proposed for elderly patients with cobalamin deficiency but with no severe neurological signs.
Assuntos
Geriatria , Hospitais Universitários , Deficiência de Vitamina B 12/etiologia , Deficiência de Vitamina B 12/terapia , Vitamina B 12/uso terapêutico , Absorção Fisiológica , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Anemia Perniciosa/complicações , Demência/complicações , Suplementos Nutricionais , Feminino , Alimentos , França , Humanos , Injeções Intramusculares , Síndromes de Malabsorção/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vitamina B 12/administração & dosagem , Deficiência de Vitamina B 12/sangue , Deficiência de Vitamina B 12/diagnósticoAssuntos
Adenocarcinoma Mucinoso/cirurgia , Adenocarcinoma/cirurgia , Doença Celíaca/etiologia , Neoplasias do Ducto Colédoco/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Adenocarcinoma Mucinoso/complicações , Adenocarcinoma Mucinoso/diagnóstico , Biópsia , Doença Celíaca/diagnóstico , Neoplasias do Ducto Colédoco/complicações , Neoplasias do Ducto Colédoco/diagnóstico , Diarreia/etiologia , Feminino , Humanos , Icterícia/etiologia , Pessoa de Meia-IdadeRESUMO
Ingestion of foreign bodies is a common happening for prison inmates. When such bodies do not pass, endoscopic or surgical retrieval is necessary. The authors report the case of a young patient in whom endoscopy failed to retrieve several intragastric foreign bodies. He was treated successfully by laparoscopic gastrotomy. The authors think that this approach is a valid alternative to laparotomy.
Assuntos
Corpos Estranhos/cirurgia , Laparoscopia , Estômago , Adulto , Humanos , Masculino , Pneumoperitônio Artificial , Estômago/cirurgiaRESUMO
Simultaneous or secondary pancreatic metastases of primary renal cancer are exceptional and usually delayed. The clinical signs of symptomatic lesions are varied and nonspecific. Computed tomography allows complete investigation and CT angiography visualizes typical hypervascularization, which can be correlated to angiographic examinations. In the light of 3 cases treated surgically with a significant clinical follow-up, the authors review the data of the literature.
