Evaluation of indicators of cobalamin deficiency defined as cobalamin-induced reduction in increased serum methylmalonic acid.

BACKGROUND: Early detection of cobalamin deficiency is clinically important, and there is evidence that such deficiency occurs more frequently than previously anticipated. However, serum cobalamin and other commonly used tests have limited ability to diagnose a deficiency state. METHODS: We investigated the ability of hematological variables, serum cobalamin, plasma total homocysteine (tHcy), serum and erythrocyte folate, gastroscopy, age, and gender to predict cobalamin deficiency. Patients (n = 196; age range, 17-87 years) who had been referred from general practice for determination of serum cobalamin were studied. Cobalamin deficiency was defined as serum methylmalonic acid (MMA) >0.26 micromol/L with at least 50% reduction after cobalamin supplementation. ROC and logistic regression analyses were used. RESULTS: Serum cobalamin and tHcy were the best predictors, with areas under the ROC curve (SE) of 0. 810 (0.034) and 0.768 (0.037), respectively, but age, intrinsic factor antibodies, and gastroscopy gave additional information. CONCLUSIONS: When cobalamin deficiency is suspected in general practice, serum cobalamin should be the first diagnostic test, and the result should be interpreted in relation to the age of the patient. When a definite diagnosis cannot be reached, MMA and tHcy determination will provide additional discriminative information, but MMA, being more specific, is preferable for assessment of cobalamin status.

[Meningoencephalitis after Mycoplasma pneumoniae infection]. / Meningoencefalitt etter infeksjon med Mycoplasma pneumoniae.

A 15 year-old boy developed meningoencephalitis two weeks after onset of a respiratory tract infection caused by Mycoplasma pneumoniae. Central nervous complications are seen in 2-7% of patients hospitalized for M pneumoniae infection. Meningoencephalitis, meningitis, ataxia, polyradiculitis, psychosis and a few cases of apoplexy have been reported. In clinical practice one should be aware of M pneumoniae in the differential diagnosis of patients with suspected microbiologically induced central nervous complications. The pathogenetic aspects and prognosis are briefly discussed.

[Ischemic hepatitis. Important differential diagnosis of increased levels of transaminases in the liver]. / Iskemisk hepatitt. En viktig differensialdiagnose ved forhøyede levertransaminaseverdier.

In patients with pathological findings in tests of liver function, ischemic hepatitis is an important differential diagnosis. This condition is most often seen in patients with coronary heart disease. Acute circulatory failure may induce reduced liver perfusion with extreme elevation in transaminase levels within three to five days. The values return to normal within five to ten days and in uncomplicated cases there is minimal cholestasis. Ischemic hepatitis may progress to fulminant hepatic failure. The diagnosis can be made by clinical examination and biochemical tests alone. Biopsy gives a characteristic picture of centrilobular liver cell necrosis which confirms the diagnosis, but is seldom necessary.