Primary gastric lymphoma presenting with vitamin B12 deficiency and achlorhydria.

Gastric lymphoma is an uncommon condition, usually presenting with epigastric pain and/or dyspepsia. There is now good evidence that infection with Helicobacter pylori (Hp) is etiologically important. We report here a case of primary gastric lymphoma presenting with vitamin B12 deficiency anemia and achlorhydria in which there was evidence of previous, but not current, infection with Hp. Vitamin B12 deficiency was proven to be due to intrinsic factor deficiency. To our knowledge, this condition has not previously been reported.

Low serum cholinesterase levels in rural workers exposed to organophosphate pesticide sprays.

An automated assay for plasma cholinesterase (CHE) activity (EC 3.1.1.8) was used to screen 44 farmworkers engaged in fruit crop spraying in the Somerset West, CP, area. Seven had markedly reduced CHE activity, at least 30% below the lower limit of the urban reference range, while the group as a whole had moderately depressed levels. A screen of 14 nursery-workers from the same farm showed a similar picture with the 1 individual engaged in spraying duties having an extremely low CHE activity of 1,595 U/I (lower normal limit for adult males is 4,687 U/I). Clinical complaints were few and were described as 'asthma' and 'chronic bronchitis' by the nursing sister in charge of the staff clinic. The mean body mass of the 7 farmworkers with substantially reduced CHE activities was 7,4 kg lower than the others and this was accompanied by significantly diminished body mass index. Removal of the 7 worst affected individuals from spraying duties for a period of 6 weeks resulted in a statistically significant increase in CHE activity of 1,700 U/I, whereas the values in the remaining workers remained unchanged. These results strongly suggest that at least 17,5% of male rural workers engaged in crop spraying suffer from chronic organosphosphate poisoning. The somewhat depressed levels of CHE activity in the rural group as a whole may also reflect chronic exposure of a lesser degree. All 7 female workers tested had enzyme activities within the normal range.

Infantile fibrosarcoma presenting as shoulder dystocia. A case report.

Congenital (infantile) fibrosarcomas are soft-tissue tumours that usually present after birth. In the case described a large tumour of the right arm caused shoulder dystocia and death of the fetus.