Defects on endoanal ultrasound and anal incontinence after primary repair of fourth-degree anal sphincter rupture: a study of the anal sphincter complex and puborectal muscle.

OBJECTIVES: To perform three-dimensional endoanal ultrasound (EAUS) after primary repair of fourth-degree anal sphincter rupture (ASR) and correlate the sonographic defects with anal incontinence (AI); to measure the axial and sagittal thickness and angle of the puborectal muscle (PRM) as well as the length of the anal canal, and then correlate these measures with AI; and to assess the interobserver measurement agreement between an inexperienced and an experienced sonologist. METHODS: EAUS was offered to 84 consecutive women, who were asked to answer a validated questionnaire after fourth-degree ASR. AI was graded according to the Wexner score and EAUS defects were graded according to the Starck score. RESULTS: Sixty-one women (73%) answered the questionnaire. The median (range) follow-up time was 5.1 (1.3-8.7) years. Thirty-three (54%) of these women underwent EAUS and were included in the study. There was no difference in the incontinence scores between women who underwent EAUS and those who did not. Eleven of the women who underwent EAUS (33%) were continent, 22 women (67%) had flatus incontinence at least once a month, of whom 12 also had incontinence for liquid stool and two had incontinence for solid stool. The median Wexner score was 2 (range, 0-12). Five of the patients (15%) had no ultrasound defects. All of the patients with Wexner scores > or = 4 had a Starck score of > or = 10. No association between ultrasound defects and AI was demonstrated, however, the angle of the PRM and parity were associated with Starck score. No clear association between the measurements of the PRM and AI was shown. The experienced observer detected more of the small defects than did the inexperienced observer. CONCLUSION: In a 1-9-year follow-up period after primary suture of fourth-degree ASR, the frequency of AI was high, at 67%. No clear association was seen between AI and sphincter defects detected on ultrasonography. There was an association between the angle of the PRM and the extent of ultrasound defects.

Impact of age and sex on sudden cardiovascular death following myocardial infarction.

OBJECTIVE: To evaluate and compare the risk of sudden cardiovascular death (SCD) and non-SCD after myocardial infarction (MI) associated with age and sex. DESIGN: Cohort study of patients admitted with an enzyme verified acute MI and discharged alive. Patients were followed up for up to four years. PATIENTS: 5983 consecutive hospital survivors of acute MI were enrolled in the TRACE (trandolapril cardiac evaluation) registry from 1990-92. Four age groups were prespecified: < 56, 56-65, 66-75, and > or = 76 years. MAIN OUTCOME MEASURES: SCD was defined as cardiovascular death within one hour of onset of symptoms. RESULTS: There were 536 SCD and 725 non-SCD. SCD mortality was 4.8% in the youngest and 15.7% in the oldest age groups. Non-SCD mortality was 3.5% and 25%, respectively. The ratio of SCD to non-SCD mortality varied from 1.44 in the youngest (< 56 years) to 0.55 in the oldest patients (> or = 76 years). Age significantly increased both SCD and non-SCD risk (p < 0.0001), but the increase in non-SCD risk was 40% higher (p < 0.0001). Male sex was associated with increased risk of SCD independently of age (risk ratio 1.34, p < 0.005). However, the absolute three year probability of SCD among women older than 66 years exceeded 10%. CONCLUSIONS: Compared with non-SCD the risk of SCD is relatively highest in the younger age groups, but the absolute risk of SCD is much higher among the upper age groups than the younger. The risk of SCD was slightly lower in women but not enough to warrant a different treatment strategy.

Substantial variability in postoperative treatment, and convalescence recommendations following vaginal repair. A nationwide questionnaire study.

BACKGROUND: Postoperative care and convalescence recommendations following vaginal surgery are generally not evidence based. The aim of this study was to describe pre and postoperative treatment, and advice and restrictions for the convalescence period, given by Danish hospital-employed gynecologists, and gynecologists in private practice, to patients undergoing vaginal repair. METHOD: In 1999 all Danish gynecologists (n=433) received a tested questionnaire about postoperative treatment and convalescence recommendations following vaginal repair. Non-responders received one reminder. OUTCOME MEASURES: Pre and postoperative treatment, and expected hospital stay. Furthermore, lifting restrictions, sick leave, and convalescence before resumption of defined activities. RESULTS: The overall response rate was 82%. The expected postoperative hospital stay was median 3 days (range, 1-7) following anterior repair, and 2 days (range, 1-7) following posterior repair. The recommended sick leave was median 6 weeks (range, 2-12) for patients with work with heavy lifts. There were substantial differences in recommendations. Recommended lifting restrictions were median 3 kg (range, 0-20) for median 4 weeks (range, 1-12), and the recommended time till recommencement of sexual intercourse was median 4 weeks (range, 0-12). The recommended convalescence was median 4-5 weeks for strenuous activities, and median 1-2 weeks for non-strenuous activities, with ranges from 0-24 weeks. The overall, great variance could not be explained by demographic differences between gynecologists. CONCLUSION: Postoperative treatment, and convalescence recommendations given by Danish gynecologists following vaginal repair, show substantial variability and are based on individual viewpoints. Evidence based guidelines and consensus are desirable.

Consequences of overutilization and underutilization of thrombolytic therapy in clinical practice. TRACE Study Group. TRAndolapril Cardiac Evaluation.

OBJECTIVES: The aim of this study was to evaluate the consequences, measured as mortality and in-hospital stroke, of the use of thrombolytic therapy among patients with acute myocardial infarction (AMI), who do not fulfill accepted criteria or who have contraindications to thrombolytic therapy (i.e., overutilization) and among patients who are withheld thrombolytic treatment despite fulfilling indications and having no contraindications (i.e., underutilization). BACKGROUND: The implementation of treatment with thrombolysis in clinical practice is not in accordance with the accepted criteria from randomized studies. The consequence has been over- and underutilization of thrombolytic therapy among patients with AMI in clinical practice. The outcome of overutilization of thrombolytic therapy has not been described previously. METHODS: We examined 6,676 consecutive patients admitted to the hospital with an AMI and recorded characteristics, in-hospital complications and long-term mortality. RESULTS: Overall, 41% of the patients received thrombolytic therapy. Thrombolytic therapy was underutilized in 14.3% and overutilized in 12.9% of the patients. The use of thrombolytic therapy was associated with reduced mortality in every subgroup examined, including patients without an accepted indication, with an accepted indication and in patients with prior stroke. The risk ratio of in-hospital stroke was not increased in connection with thrombolytic therapy, not even in patients with prior stroke (relative risk = 0.237, 95% confidence interval: 0.031 to 1.810, p = 0.17). CONCLUSIONS: With the large benefit known to be associated with thrombolytic therapy and the favorable result of thrombolytic therapy in patients with contraindications observed in this study, we conclude that a formal evaluation of thrombolytic therapy in wider patient categories is warranted.

[Convalescence recommendations after hysterectomy. A study of opinions among Danish physicians]. / Rekonvalescensrekommandationer efter hysterektomi. En undersøgelse af danske laegers holdninger.

INTRODUCTION: The aim of this study was to describe advice and restrictions given by Danish general practitioners (GPs) and gynaecologists to patients after uncomplicated hysterectomy. MATERIALS AND METHODS: Four hundred and ninety-one randomly selected GPs and 433 gynaecologists received a postal questionnaire in 1998/1999. The questions concerned the length of recommended sick leave, lifting restrictions, and time to resumption of seven defined common activities after hysterectomy. In addition, the gynaecologists were asked about the use of vaginal packaging, bladder catheters, and expected length of hospital stay. RESULTS: The total response rate was 72%. GPs and gynaecologists recommended a median of 4 weeks (1-8 weeks) of convalescence after hysterectomy to patients, whose work did not involve heavy lifting, and a median of six weeks (2-12 weeks) to women, whose work did. Responses concerning the resumption of common activities showed considerable variation, for instance patients were advised to postpone sexual intercourse for a median of four weeks postoperatively (0-12 weeks). Lifting restrictions varied from lifting a maximum of 15 kg for two weeks to a maximum of 2 kg for 12 weeks. CONCLUSION: A considerable variation was found in recommendations and regimens for hysterectomised patients. Evidence-based guidelines do not exist, and until these are available, the national and local boards of physicians need to agree on what restrictions should be given to patients.

Serum-ionised magnesium in patients with acute myocardial infarction. Relation to cardiac arrhythmias, left ventricular function and mortality.

Measurement of serum-ionised magnesium has recently become available, and we report the first study of the relation of this parameter to arrhythmias, left ventricular function and mortality in patients with an acute myocardial infarction. Serum-ionised magnesium was determined in 217 consecutive patients admitted to hospital with an enzyme confirmed AMI. 70 healthy subjects acted as a control group. The main study parameters were occurrence of arrhythmias, left ventricular function estimated by echocardiography, and mortality after 10 months for the AMI patients. AMI patients had significantly lower serum-ionised magnesium compared to healthy controls but the level of serum-ionised magnesium in the acute phase of a MI was neither related to arrhythmias, left ventricular function nor mortality.

Age-distribution, risk factors and mortality in smokers and non-smokers with acute myocardial infarction: a review. TRACE study group. Danish Trandolapril Cardiac Evaluation.

Smoking is a risk factor for acute myocardial infarction; paradoxically, many studies have shown a lower post-infarct mortality among smokers. There are some important differences between smokers and non-smokers, which might explain the observed difference in mortality: smokers have less multivessel disease and atherosclerosis but are more thrombogenic; thrombolytic therapy seems to be more effective among smokers; smoking might result in an increased out-of-hospital mortality rate, by being more arrhythmogenic; and smokers are on average a decade younger than non-smokers at the time of infarction, and have less concomitant disease. Adjusting for these differences in regression analyses shows that smoking is not an independent risk factor for mortality after acute myocardial infarction. The difference in age and risk factors are responsible for the lower mortality among smokers.

The prognostic importance of smoking status at the time of acute myocardial infarction in 6676 patients. TRACE Study Group.

Smoking is an important risk factor for atherosclerotic heart disease, but several studies have shown smoking to be associated with a favourable prognosis in patients who have suffered an acute myocardial infarction (AMI). We studied a large group of consecutive patients admitted alive to hospital with an infarction in order to further study the prognostic importance of smoking status at the time of myocardial infarction. The study cohort comprised 6676 patients with an enzyme-confirmed myocardial infarction admitted to 27 Danish hospitals over a 26-month period between 1990 and 1992. Smoking status was determined at the time of hospitalisation and complete follow-up was obtained in October 1996. Smokers were on average 10 years younger, had fewer concomitant cardiac risk factors, and were more likely to be male and to receive thrombolytic therapy more frequently than non-smokers. In univariate analysis, smoking was associated with reduced 30-day and long-term mortality (risk ratio at 30 days 0.55, P < 0.001, risk ratio long-term 0.59, P < 0.001). When age only was included in a multivariate analysis, smoking was no longer of importance in short- or long-term mortality (risk ratio 0.92, P = 0.4 at 30 days and long-term risk ratio 0.98, P = 0.7). Inclusion of further variables did not change this picture. In conclusion, smoking contributes to the occurrence of AMI at a younger age. The more favourable prognosis in smokers at the time of AMI is a result of more favourable baseline characteristics, especially their lower age.

[Placenta accreta. Bleeding and disseminated intravascular coagulation following Cesarean section]. / Placenta accreta. Blødning og dissemineret intravaskuloer koagulation efter kejsersnit.

A case of placenta accreta in a 30-year old woman with one prior caesarean section is presented. The operative course of her second caesarean section was complicated by mild atonia. The postoperative course was complicated by mild atonia, which was followed by excessive vaginal and intraabdominal bleeding due to atonia and disseminated intravascular coagulation. An abdominal hysterectomy was performed. Risk factors, antenatal diagnostic methods, complications and different treatment aspects are discussed.

Long-term prognosis after acute myocardial infarction in patients with a history of arterial hypertension. TRACE study group.

AIMS: The objective of the study was to investigate the influence of a history of arterial hypertension on long-term prognosis after an acute myocardial infarction in a representative population, and secondly to assess the impact on prognosis of left ventricular systolic function in hypertensives after acute myocardial infarction. METHODS: A retrospective analysis of survival data on 6676 patients with acute myocardial infarction screened for entry into the TRAndolapril Cardiac Evaluation (TRACE) study. Follow-up time was 4-6 years. RESULTS: One thousand five hundred and seven (23%) of the patients had a history of arterial hypertension. During the time of observation 763 (50.6%) hypertensives and 2253 (43.7%) normotensives died, corresponding to a risk ratio for death in hypertensives of 1.23 (1.13-1.33, P < 0.0001). In a multivariate analysis considering 12 other major risk factors after myocardial infarction, the risk ratio for death in hypertensives was 1.14 (1.04-1.24). There was a significant interaction between hypertension and age. Thus, hypertension only increased risk in patients aged 65 years or less (P < 0.001). No interaction with left ventricular systolic function was found. CONCLUSION: A history of arterial hypertension is a moderate risk factor for mortality after an acute myocardial infarction in patients aged 65 years or less. This excess risk is present at all levels of left ventricular systolic function.

[Delay from start of symptoms to hospital admission among 5.978 patients with acute myocardial infarction]. / Forsinkelse fra symptomdebut til ankomst på hospital blandt 5.978 patienter med akut myokardieinfarkt.

The aim of this study was to analyse the influence of patient characteristics on delay between onset of symptoms and hospital admission (patient delay) in acute myocardial infarction. A group of 6676 consecutive patients with AMI, admitted alive to 27 Danish hospitals from 1990 to 1992, were studied. Due to missing information on delay or in hospital acute myocardial infarction 698 patients were excluded. Mean patient delay was 9.1 hours, median delay 3.25 hours (5 to 95 percentiles: 0.67-40 hours). In multivariate logistic regression analysis patient delay was independently associated with male gender, increased age, diabetes mellitus, left ventricular systolic function (wall motion index), onset from midnight to 6 a.m., onset on a weekday, history of angina pectoris, chest pain as initial symptom, ventricular fibrillation or-tachycardia, Killip class > or = 3, presence of ST-elevation and ST-depressions. In conclusion, patient delay continues to be disappointingly long. This also applies to patients with a high risk of acute myocardial infarction (notably history of diabetes mellitus and angina pectoris).

Captopril does not blunt the sympathoadrenal response to cigarette smoking in normotensive humans.

The aim of this study was to assess whether an interaction exists between the renin-angiotensin system and the sympathetic nervous system at the level of the adrenal medulla during smoking in normal humans. Thirteen habitual smoking volunteers were studied in a randomized, single-dose, double-blind, cross-over fashion using 50 mg captopril vs placebo followed by smoking of two high nicotine content cigarettes within 15 min. Blood samples were obtained at frequent intervals before, during and after smoking. We found that the increase in plasma adrenaline concentration during cigarette smoking was modest. There was no difference between captopril treatment as compared to placebo. Thus, the adrenaline response to cigarette smoking was not blunted by acute blockade of angiotensin II generation. A significant increase in heart rate, and blood pressure was found as well. No increase in plasma noradrenaline concentration was found. Plasma renin concentration increased significantly during captopril treatment, whereas it decreased throughout the study period in the placebo phase. Plasma angiotensin II concentration decreased in both the captopril treatment and the placebo phase throughout the study period, but this was more pronounced during captopril treatment. In conclusion, cigarette smoking-induced activation of the sympathetic nervous system was not blunted by acute ACE-inhibition by captopril. This indicates that angiotensin II does not facilitate smoking-induced activation of sympathoadrenal activity in humans.

Influence of age on the prognostic importance of left ventricular dysfunction and congestive heart failure on long-term survival after acute myocardial infarction. TRACE Study Group.

The aim of this study was to assess the importance of congestive heart failure and left ventricular (LV) systolic dysfunction after an acute myocardial infarction (AIM) on long-term mortality in different age groups. A total of 7,001 consecutive enzyme-confirmed AMIs (6,676 patients) were screened for entry into the TRAndolapril Cardiac Evaluation (TRACE) study. Medical history, echocardiographic estimation of LV systolic function determined as wall motion index, infarct complications, and survival were documented for all patients. To study the importance of congestive heart failure and wall motion index independent of age, we performed Cox proportional-hazard models in 4 different age strata (< or = 55 years, 56 to 65 years, 66 to 75 years, and > 75 years). Patients in these strata had 1-year mortality rates of 5%, 11%, 21%, and 32%, respectively. Three-year mortality rates were 11%, 20%, 34%, and 55%, respectively. The risk ratios (and 95% confidence limits) associated with congestive heart failure in the same 4 age strata were 1.9 (1.3 to 2.9), 2.8 (2.1 to 3.7), 1.8 (1.5 to 2.2) and 1.8 (1.5 to 2.2), respectively. The risk ratios associated with decreasing wall motion index were 6.5 (3.6 to 11.4), 3.3 (2.3 to 4.6), 2.7 (2.2 to 3.4), and 2.1 (1.7 to 2.6), respectively. In absolute percentages, there was an excess 3-year mortality associated with congestive heart failure in the 4 age strata of 14%, 24%, 25%, and 28% respectively. The absolute excess in 3-year mortality associated with LV systolic dysfunction in the 4 age strata was 15%, 19%, 25%, and 21%, respectively. Thus, the relative importance of LV systolic dysfunction and congestive heart failure diminished with increasing age. However, the absolute excess mortality associated with congestive heart failure and LV systolic dysfunction was more pronounced in the elderly than in the young.

Influence of gender on short- and long-term mortality after acute myocardial infarction. TRACE study group.

The aim of this study was to assess differences in short- and long-term mortality between male and female patients with acute myocardial infarction (AMI). The study population consisted of 6,676 consecutive patients admitted alive with an enzyme-confirmed AMI to 27 Danish hospitals from 1990 to 1992. Five patients were excluded because of missing information. Female patients (n = 2,170) were on average 5 years older than male patients (n = 4,501, p <0.001), had lower body mass index, and more often had diabetes, hypertension, and congestive heart failure. Left ventricular systolic function was the same for men and women. Women received thrombolytic therapy less often. The 1-year mortality for female patients was 28 +/- 1% and for men 21 +/- 1% (p <0.001). The unadjusted risk ratio associated with male gender in a proportional-hazards model was 0.76 (95% confidence intervals [CI] 0.70 to 0.83). Adjustment for age removed the importance of gender, and the risk ratio associated with male gender was 1.06 (95% CI 0.97 to 1.2, p = 0.2). An introduction of further variables in the model did not change this. Subdividing mortality into 6-day, 30-day, and late mortality demonstrated a significantly increased mortality in women in the short-term (6 and 30 days), with a risk ratio in men of 0.58 (95% CI 0.42 to 0.81) and 0.80 (95% CI 0.65 to 0.99), respectively. From day 30 onward there was an increased mortality in men with a risk ratio of 1.16 (95% CI 1.03 to 1.31, p = 0.01). Thus, women admitted alive to the hospital with an AMI have an increased long-term mortality that is explained by their older age. However, short-term mortality in women seems to increase independently of other risk factors, but is later followed by an increase in mortality in men.

Determinants of delay between symptoms and hospital admission in 5978 patients with acute myocardial infarction. The TRACE Study Group. Trandolapril Cardiac Evaluation.

The aim of this study was to analyse the influence of patient characteristics on delay between onset of symptoms and hospital admission (patient delay) in acute myocardial infarction, and especially to assess the impact of risk factors for acute myocardial infarction on patient delay. A group of 6676 consecutive patients with enzyme-confirmed acute myocardial infarction, admitted alive to 27 Danish hospitals over a 26 month period from 1990 to 1992, were studied. Due to missing information on delay or in-hospital acute myocardial infarction 698 patients were excluded, leaving 5978 patients for analysis. Mean patient delay was 9.1 h, median delay 3.25 h (5 to 95 percentiles: 0.67-40.0 h). Thirty-four percent were admitted within the first 2 h, 68% within 6 h and 81% within 12 h of onset of symptoms. In multivariate logistic regression analysis, a greater than 2 h patient delay was independently associated with male gender (odds ratio (OR) = 0.809, P = 0.003), increased age (P = 0.0001), diabetes mellitus (OR = 1.269, P = 0.03), left ventricular systolic function (wall motion index) (P = 0.02), onset from midnight to 0600h (OR = 1.434, P = 0.0001), onset on a weekday (OR = 0.862, P = 0.04), history of angina pectoris (OR = 1.198, P = 0.02), chest pain as initial symptom (OR = 1.293, P = 0.02), ventricular fibrillation (OR = 0.562, P = 0.0001), ventricular tachycardia (OR = 0.620, P = 0.0001), Killip class > or = 3 (OR = 0.709 P = 0.002), presence of ST elevation (OR = 0.810, P = 0.01) and ST depressions (OR = 0.847, P = 0.01). All these variables, except history of diabetes mellitus, angina pectoris, and chest pain as an initial symptom were also associated with a delay of more than 6 h. Thrombolytic therapy was administered to 55.8% of patients admitted within 2 h of an acute myocardial infarction, 48.5% of patients admitted within 2-6 h, 31.5% of patients admitted after 6-12 h and 11.9% of patients arriving later than 12 h after start of symptoms. CONCLUSION. Patient delay continues to be disappointingly long. This also applies for patients at a high risk of acute myocardial infarction (notably those with a history of diabetes mellitus and angina pectoris).

[Chlamydia trachomatis]. / Chlamydia trachomatis.

Almost 11,000 cases of Chlamydia trachomatis (CT) are diagnosed every year in Denmark. The most important epidemiologic factor is age under 25 years. The prevalence of CT among women applying for legal abortion is five to eight percent and in a recent study the prevalence of CT among second trimester pregnant women was found to be 2.9 percent. The consequences of CT-caused infections are many, including risk of infertility, ectopic pregnancies, perinatal transmission etc. The perinatal transmission rate is high in untreated cases of CT during pregnancy, but it can be prevented by treatment of the expecting woman with erythromycin. The Danish National Board of Health do recommend screening for CT before transcervical interventions, but there are no such recommendations concerning pregnancy health care. A recent Danish study as well as many other studies have shown that it is cost-effective to screen high risk women i.e. women younger than 25 years. An introduction of such screening of Danish pregnant women younger than 25 years should therefore be considered.

[Chlamydia trachomatis in pregnant women in the county of Vestsjaelland. Prevalence, prevention of perinatal transmission and cost-effectiveness of screening]. / Chlamydia trachomatis hos gravide i Vestsjaellands Amt. Proevalens, forebyggelse of perinatal smitte og cost-effektivitet ved screening.

The prevalence of genital Chlamydia trachomatis (CT) in pregnant women and the perinatal transmission after treatment was investigated. An analysis of the cost-effectiveness of introducing a screening program among women at risk of having CT was made. Out of 339 pregnant women 2.9% had cervical CT. CT-positive women were treated with erythromycin. CT-positive women were significantly younger than CT-negative women and the odds ratio (OR) of having CT if nulliparous was 3.35. The CT-prevalence was 6.6% among women younger than 25 years and 1.6% among women 25 years or older (p = 0.0163). OR of having CT if younger than 25 years was 4.3. The young women were significantly younger at sexual début. None of the children of women treated for CT during pregnancy developed neonatal CT-conjunctivitis. The screening of women younger than 25 years was considered to be cost-effective. It is concluded that women younger than 25 years are at risk of having CT. Treatment of CT-positive women with erythromycin during pregnancy seems to be effective in eradicating this microorganism and thus preventing perinatal transmission and neonatal CT-conjunctivitis. It therefore seems rational to screen all pregnant women under the age of 25 years for cervical CT, especially in high risk areas.

[Vagal atrial arrhythmia syndrome]. / Vagal atrial arytmi-syndrom.

A case of paroxysmal atrial fibrillation with a vagal origin is presented. The vagal atrial arrhythmia syndrome is characterized by episodes of atrial fibrillation of flutter that most often occur postprandially or during the night. Episodes are precipitated by mild bradycardia. They should be classified as "lone" atrial fibrillation, and do not tend to become chronic. A rational medical approach is proposed.

Thyroid function and autoimmunity in pernicious anemia before and during cyanocobalamin treatment.

Out of 35 consecutive patients with decreased plasma-cobalamin 22 had newly diagnosed overt pernicious anemia (PA) six of which had a known history of thyroid disease. At referral, 5 of these 6 were thyroid peroxidase antibody (TPOAb)-positive and 2 were thyroglobulin antibody (TgAb)-positive, while none were thyroid stimulating antibody (TSAb)-positive (an overall autoantibody appearance of 83.3%). Fifty percent of the 22 patients had TPOAb and 13.6% had TgAb compared to 18.2% and 4.5%, respectively in sex and age matched healthy controls. Six PA-patients without a history of thyroid disease had thyroid autoantibodies and another patient seroconverted within the first year during treatment with cyanocobalamin. Measurements of serum concentrations of thyroid hormones and thyroid stimulating hormone were performed during the first year of treatment with cyanocobalamin. Two cases of subclinical myxoedema were found among PA-patients and another case was found among patients with latent PA. The female:male ratio of thyroid disease among PA-patients and among thyroid autoantibody-positive PA-patients was interestingly found to be 1:1. Treatment with cyanocobalamin did not have any systematic effect on thyroid function. Routine screening for thyroid function and thyroid autoantibodies in patients with latent or overt PA is recommended.