vitamin-b-12 and Atrophy

Atrophic glossitis (AG) is characterized by the partial or complete absence of filiform papillae on the dorsal surface of the tongue. AG may reflect the significant deficiencies of some major nutrients including riboflavin, niacin, pyridoxine, vitamin B12, folic acid, iron, zinc, and vitamin E. Moreover, protein-calorie malnutrition, candidiasis, Helicobacter pylori colonization, xerostomia, and diabetes mellitus are also the etiologies of AG. Our previous study found the serum gastric parietal cell antibody (GPCA), thyroglobulin antibody (TGA), and thyroid microsomal antibody (TMA) positivities in 26.7%, 28.4%, and 29.8% of 1064 AG patients, respectively. We also found anemia, serum iron, vitamin B12, and folic acid deficiencies, and hyperhomocysteinemia in 19.0%, 16.9%, 5.3%, 2.3%, and 11.9% of 1064 AG patients, respectively. Moreover, GPCA-positive AG patients tended to have relatively higher frequencies of hemoglobin, iron, and vitamin B12 deficiencies and hyperhomocysteinemia than GPCA-negative AG patients. Supplementations with vitamin BC capsules plus corresponding deficient hematinics for those AG patients with hematinic deficiencies can achieve complete remission of oral symptoms and AG in some AG patients. Therefore, it is very important to examine the complete blood count, serum hematinic, homocysteine, and autoantibody levels in AG patients before we start to offer treatments for AG patients.

Topics: Anemia; Atrophy; Autoantibodies; Erythrocyte Indices; Folic Acid; Folic Acid Deficiency; Glossitis; Hemoglobins; Humans; Hyperhomocysteinemia; Iron; Parietal Cells, Gastric; Vitamin B 12; Vitamin B 12 Deficiency

Combined medullary sclerosis developed suddenly postoperatively in a patient with unknown Biermer's disease. The neurological lesions were undoubtedly induced by nitrogen protoxide via an inactivation of vitamin B12.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Abscess; Aged; Anemia, Pernicious; Anesthetics, Inhalation; Arthroplasty, Replacement, Hip; Atrophy; Autoantibodies; Autoimmune Diseases; Demyelinating Diseases; Female; Gastric Mucosa; Humans; Intestinal Absorption; Intrinsic Factor; Nitrous Oxide; Oxidation-Reduction; Paresthesia; Postoperative Complications; Proprioception; S-Adenosylmethionine; Sclerosis; Spinal Cord; Spinal Cord Diseases; Surgical Wound Infection; Vitamin B 12

Topics: Adrenal Cortex Hormones; Adult; Anemia, Pernicious; Atrophy; Autoantibodies; Autoimmune Diseases; Binding Sites, Antibody; Child; Gastric Juice; Gastric Mucosa; Gastrins; Gastritis; Humans; Immunity, Cellular; Immunoglobulin A; Immunoglobulin G; Intrinsic Factor; Vitamin B 12

Topics: Age Factors; Anemia, Pernicious; Antibodies; Atrophy; Bethanechol Compounds; Carbachol; Gastric Juice; Gastric Mucosa; Gastrins; Gastritis; Histamine; Humans; Insulin; Intrinsic Factor; Methacholine Compounds; Vitamin B 12; Vitamin B 12 Deficiency

The effects of B vitamins on mild cognitive impairment (MCI) patients' cognition have been mixed, suggesting the existence of moderating factors.. A post hoc analysis of a negative B vitamin trial was performed to examine the potential modulating effect of regional brain atrophy on the cognitive response to B vitamins in MCI patients.. In the 24-month randomized trial, 279 MCI outpatients took 500μ#x03BC;g methylcobalamin and 400μ#x03BC;g folic acid once per day or placebo tablets once per day. Sixty-four aspirin users were excluded from analysis as aspirin use has been found to have significant negative interaction effects. Subjects were followed up at months 12 and 24. The primary cognitive outcome was clinical dementia rating scale sum of boxes (CDR_SOB). In a subgroup of 83 subjects, MRI brain scans were performed at baseline to estimate regional brain atrophy ratios.. Among the trial subjects who had MRI data, B vitamin supplementation had no significant effect on CDR_SOB, despite having significant homocysteine lowering effects. The atrophy ratio of the left frontal lobe significantly moderated the effect of B vitamin supplementation on CDR_SOB, after adjusting for confounders, in that B vitamin supplementation was associated with lower CDR_SOB scores (i.e., better cognitive function) at the 24th month among those patients with above median atrophy ratios, but not among those with lower atrophy ratios, in the left frontal lobe.. B vitamins may be more effective in slowing down cognitive decline in MCI patients with atrophy in the left frontal lobe.

Topics: Aspirin; Atrophy; Cognition; Cognitive Dysfunction; Dietary Supplements; Folic Acid; Frontal Lobe; Homocysteine; Humans; Vitamin B 12; Vitamin B Complex

Although patients harboring confluent white matter hyperintensities (WMH) are at high risk of cognitive decline, this risk varies among individuals. We investigated the predictors for cognitive decline in stroke patients with confluent WMH.. We followed up 100 stroke patients with confluent WMH who were participants of the VITAmins TO Prevent Stroke study for 2 years. We investigated the association between clinical features, apolipoprotein E status, imaging measures (infarcts, microbleeds, volumes of WMH, cortical gray matter [cGM], lateral ventricles, and hippocampi), and B vitamins with changes in cognitive measures (clinical dementia rating scale, Mini-Mental State Examination, Mattis dementia rating scale--initiation/perseveration subscale). We performed Pittsburgh compound B imaging among dementia converters.. Multivariate regression analysis showed that increase in clinical dementia rating scale grade was associated with cGM atrophy, absence of hyperlipidemia, and lower diastolic blood pressure at baseline. cGM atrophy and absence of hyperlipidemia were also associated with deterioration in Mini-Mental State Examination and Mattis dementia rating scale--initiation/perseveration subscale scores. Pittsburgh compound B retention typical of Alzheimer's disease was found only in 10% of dementia converters. Incident stroke and B vitamins were not associated with cognitive decline.. Among stroke patients with confluent WMH, cGM atrophy and absence of hyperlipidemia are important predictors for cognitive decline. Significant cognitive decline can occur in the absence of incident stroke or Alzheimer's pathology.

Topics: Aged; Atrophy; Brain; Cognition Disorders; Double-Blind Method; Female; Folic Acid; Humans; Magnetic Resonance Imaging; Male; Nerve Fibers, Myelinated; Secondary Prevention; Stroke; Vitamin B 12; Vitamin B 6; Vitamin B Complex

Topics: Atrophy; Autoimmune Diseases; Female; Gastritis; Gastritis, Atrophic; Humans; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency

The purpose of the study was to evaluate the clinical patterns of atrophy of the filiform papillae (FP) of the tongue and their relationship with the serum levels of iron and vitamin B. A cross-sectional, analytical, research study was designed. A systematic tongue examination was performed to evaluate the presence and clinical patterns of FP atrophy. We collected epidemiologic, clinical, and laboratory data. Statistical analysis included χ. A total of 87 patients (83.9% females) were included [median age = 55 (range 20-89) years]. Endocrinopathy (60.9%) was the most frequent comorbidity. We found atrophy of the FP in 90.8% of the patients; the atrophy was mild in 83.5% of the cases, and severe in 16.5%. The most common atrophic patterns were as follows: focalized in 64 (73.6%) cases, "U"-shaped pattern in 60 (69%), and generalized in 30 (34.5%). Geographic tongue and median rhomboid glossitis were observed in 12 (13.8%) and 11 (12.6%) subjects, respectively. Lower titers of serum iron were detected in cases with focal (median = 71 vs. 110 mcg/dl) and generalized (median = 55 vs. 78 mcg/dl) FP atrophy (P = 0.03 and P = 0.009, respectively), than their counterparts. The presence of symptomatology was related to the focal pattern of atrophy (P = 0.038).. A high frequency of filiform papillary atrophy of the tongue was observed in patients with comorbidities. Some atrophic patterns of the tongue were significantly associated with certain medical conditions.

Topics: Adult; Aged; Aged, 80 and over; Atrophy; Cross-Sectional Studies; Female; Folic Acid; Humans; Iron; Male; Middle Aged; Tongue; Vitamin B 12; Young Adult

Vitamin B12 is inextricably associated with the development and maintenance of neuronal functions. It is classically associated with subacute combined degeneration and peripheral neuropathy; however, cranial neuropathy is uncommon. We observed the rarest neurological manifestation of B12 deficiency. A 12 months infant had history of lethargy, irritability, anorexia, paleness, vomiting, and neurodevelopmental delay for 2 months. He also developed inattention and altered sleep pattern. His mother noticed bilateral inward rotation of both eyes. On examination, the infant had bilateral lateral rectus palsy. The infant was found to have anemia (7.7g/dL) and severe B12 deficiency (74pg/mL). On MRI, there was cerebral atrophy, subdural hematoma (SDH) and wide cisternal spaces and sulci. On supplementation with cobalamin, he improved clinically though mild restriction of lateral gaze on the left side persists. Follow up MRI showed significant improvement in cerebral atrophy with resolution of SDH. To date, such clinical presentation of B12 deficiency has never been reported. The authors suggest B12 supplementation for at risk population esp at antenatal stage and lactating mothers in national programs. The treatment of this condition should be initiated early to prevent long term sequelae.

Topics: Abducens Nerve Diseases; Atrophy; Female; Hematoma, Subdural; Humans; Infant; Lactation; Male; Pregnancy; Vitamin B 12; Vitamin B 12 Deficiency

Nitrous oxide is among the most common drugs used by adolescents and young adults, and its neuropsychiatric sequelae are severe but reversible with timely treatment. The causal mechanism relates to impaired metabolism of vitamin B12, which is necessary for the development and maintenance of the myelin sheath. Individuals most susceptible to neuropsychiatric manifestations are those with a secondary cause of vitamin B12 deficiency, including nutritional deficiency and impaired absorption, or an alternative cause of impaired metaboclism. We describe the case of a man in his thirties who developed subacute combined degeneration of the spinal cord and polyneuropathy in the setting of recreational nitrous oxide use and autoimmune atrophic gastritis. Our case highlights clinical pearls for diagnosis and treatment, differential diagnosis, common concomitant aetiologies and the importance of screening for substance use disorder and psychiatric comorbidities.

Topics: Adolescent; Atrophy; Gastritis; Gastritis, Atrophic; Humans; Male; Nitrous Oxide; Spinal Cord; Subacute Combined Degeneration; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Vitamin B12 deficiency can be seen in the cases with sleeve gastrectomy. Because the chief factor in vitamin B12 deficiency is gastric atrophy, we aimed to evaluate the effect of atrophy on postoperative vitamin B12 levels in patients who underwent sleeve gastrectomy.. Sixty patients were included in this study. Vitamin B12 levels were compared with presence of atrophy before the operation and after vitamin B12 supplementation.. Atrophy was observed in 37 (61.7%) of the cases; 23 (38.3%) patients had no atrophy. There was a statistically significant difference between the presence of atrophy and vitamin B12 levels (p = 0.024). Despite vitamin B12 support, there were statistically significant low vitamin B12 levels after the operation in female patients having atrophy (p = 0.023). The same significance was not observed in males (p = 0.480).. Vitamin B12 deficiency following obesity surgery is a condition that must be monitored and prevented. We found that histopathologically confirmed atrophy had an adverse effect on postoperative vitamin B12 levels. These findings can be a guide for the clinicians in the management of these cases.. La deficiencia de vitamina B12 se puede observar en los casos de gastrectomía en manga. Debido a que el factor principal en la deficiencia de vitamina B12 es la atrofia gástrica, nuestro objetivo fue evaluar el efecto de la atrofia en los niveles posoperatorios de vitamina B12 en pacientes que se sometieron a gastrectomía en manga.. se incluyeron 60 pacientes en este estudio. Los niveles de vitamina B12 se compararon con la presencia de atrofia antes de la operación y después de la suplementación con vitamina B12.. Se observó atrofia en 37(61.7%) de los casos; 23 (38.3%) pacientes no presentaron atrofia. Hubo una diferencia estadísticamente significativa entre la presencia de atrofia y los niveles de vitamina B12 (p = 0.024). A pesar del apoyo de vitamina B12, hubo niveles bajos de vitamina B12 estadísticamente significativos después de la operación en pacientes femeninas con atrofia (p = 0.023). No se observó la misma significación en los hombres (p = 0.480).. La deficiencia de vitamina B12 luego de una cirugía de obesidad es una condición que debe ser monitoreada y prevenida. Encontramos que la atrofia confirmada histopatológicamente tuvo un efecto adverso sobre los niveles posoperatorios de vitamina B12. Estos hallazgos pueden ser una guía para los médicos en el manejo de estos casos.

Topics: Atrophy; Dietary Supplements; Female; Gastrectomy; Humans; Male; Obesity, Morbid; Vitamin B 12; Vitamin B 12 Deficiency

Vitamin B12 deficiency is associated with cognitive impairment, hyperhomocysteinemia, and hippocampal atrophy. However, the recovery of cognition with vitamin B12 supplementation remains controversial. Of the 1716 patients who visited our outpatient clinic for dementia, 83 had vitamin B12 deficiency. Among these, 39 patients (mean age, 80.1 ± 8.2 years) had undergone Mini-Mental State Examination (MMSE) and laboratory tests for vitamin B12, homocysteine (Hcy), and folic acid levels. The hippocampal volume was estimated using the z-score of the MRI-voxel-based specific regional analysis system for Alzheimer’s disease. This is multi-center, open-label, single-arm study. All the 39 patients were administered vitamin B12 and underwent reassessment to measure the retested for MMSE and Hcy after 21−133 days (median = 56 days, interquartile range (IQR) = 43−79 days). After vitamin B12 supplementation, the mean MMSE score improved significantly from 20.5 ± 6.4 to 22.9 ± 5.5 (p < 0.001). Hcy level decreased significantly from 22.9 ± 16.9 nmol/mL to 11.5 ± 3.9 nmol/mL (p < 0.001). Significant correlation was detected between the extent of change in MMSE scores and baseline Hcy values. The degree of MMSE score was not correlated with hippocampal atrophy assessed by the z-score. While several other factors should be considered, vitamin B12 supplementation resulted in improved cognitive function, at least in the short term, in patients with vitamin B12 deficiency.

Topics: Aged; Aged, 80 and over; Atrophy; Cognition; Cognitive Dysfunction; Dietary Supplements; Folic Acid; Homocysteine; Humans; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

People with a migration background are underrepresented in dementia research and disfavored in assessment and treatment, and many foreign-born individuals with dementia remain undiagnosed.. The aim of this study was to examine whether there is inequality in the clinical assessment of dementia between native and foreign-born individuals in Sweden.. Information was gathered retrospectively from a cohort of 91 native and 36 foreign-born patients attending four memory clinics in Skåne, Sweden. Data included information on cognitive test results, cerebrospinal fluid biomarkers, scores at structural imaging scales of global cortical atrophy (GCA), medial temporal lobe atrophy (MTA) and the Fazekas scale, laboratory measures of thyroid-stimulating hormone, calcium, albumin, homocysteine, hemoglobin, cobalamin (vitamin B12), and folate (vitamin B9), contact with health care, and treatment.. Foreign-born patients had lower educational level and scored lower on Mini-Mental State Examination and Clock Drawing Test (p < 0.001-0.011). Relatives initiated contact with health care to a higher extent in the foreign-born group (p = 0.031). Foreign-born patients had less white matter lesions (p = 0.018). Additionally, Alzheimer's disease (AD) biomarkers were significantly less used in foreign-born patients to support an AD diagnosis (p = 0.001). No significant differences were found for scores on GCA and MTA, laboratory measures, or initiated treatment.. Although native and foreign-born patients were predominantly homogenous regarding examined variables, differences in the diagnostic process and underlying biological correlates of dementia exist and need to be further investigated in a larger sample.

Topics: Albumins; Alzheimer Disease; Atrophy; Biomarkers; Calcium; Cognitive Dysfunction; Folic Acid; Homocysteine; Humans; Magnetic Resonance Imaging; Retrospective Studies; Sweden; Thyrotropin; Vitamin B 12

Existing studies have reported the significant association between atrophic glossitis (AG) and hematinic deficiencies, including iron, folate and vitamin B12 deficiency. However, these findings were inconsistent. AG can be graded as partial or complete atrophy. It is still unclear whether hematinic deficiencies are associated with the grading of AG.. 236 AG patients and 208 sex- and age-matched healthy controls were enrolled in this study. Hematological tests including complete blood count, and serum levels of folate, ferritin and vitamin B12 were performed. The AG group was divided into those with partial AG and those with complete AG according to the extent of papillary atrophy. Statistical analysis was performed to assess whether hematinic deficiencies are risk factors for AG and its grading.. Compared with the healthy controls, AG patients had significantly higher frequencies of vitamin B12 deficiency (68.22%), ferritin deficiency (13.98%) and anemia (21.61%). The differences in hematinic deficiencies and anemia between AG patients and healthy controls changed according to gender and age. The frequencies of serum vitamin B12 deficiency and anemia in the complete AG subgroup were significantly higher than those in the partial AG subgroup. Logistic regression analysis revealed that vitamin B12 deficiency and anemia were significantly correlated with AG and its grading. The AG patients with vitamin B12 deficiency responded well to supplement therapy.. AG could be an important clinical indicator for potential vitamin B12 deficiency, especially when the degree of tongue atrophy more than 50% and complete atrophy. Vitamin B12 deficiency might play an etiological role in the development of AG.

Topics: Anemia; Atrophy; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Ferritins; Folic Acid; Glossitis; Hematinics; Hemoglobins; Humans; Hyperhomocysteinemia; Parietal Cells, Gastric; Tongue; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Aged; Aluminum; Atrophy; Brain; Cognitive Dysfunction; Copper; Female; Folic Acid; Humans; Iron; Male; Mass Spectrometry; Neuropsychological Tests; Silicon; Vitamin B 12; Vitamin B 6

Our previous study found that 127 of 1064 atrophic glossitis (AG) patients have hyperhomocysteinemia. This study assessed whether the AG patients with hyperhomocysteinemia had significantly higher frequencies of anemia, hematinic deficiencies, and serum gastric parietal cell antibody (GPCA) positivity than AG patients without hyperhomocysteinemia or healthy control subjects.. The blood hemoglobin (Hb) and serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 127 AG patients with hyperhomocysteinemia, 937 AG patients without hyperhomocysteinemia, and 532 healthy control subjects were measured and compared.. We found that 127 AG patients with hyperhomocysteinemia had significantly higher frequencies of blood Hb and serum iron, vitamin B12, and folic acid deficiencies and serum GPCA positivity than 532 healthy control subjects (all P-values < 0.001) and significantly higher frequencies of blood Hb and serum vitamin B12 and folic acid deficiencies and serum GPCA positivity than 937 AG patients without hyperhomocysteinemia (all P-values < 0.001). Moreover, 127 AG patients with hyperhomocysteinemia had significantly higher frequencies of macrocytic anemia and significantly lower frequencies of normocytic anemia than 937 AG patients without hyperhomocysteinemia (both P-values < 0.001). Pernicious anemia (22 cases) was found only in AG patients with hyperhomocysteinemia but not in AG patients without hyperhomocysteinemia.. AG patients with hyperhomocysteinemia had significantly higher frequencies of anemia, serum iron, vitamin B12, and folic acid deficiencies, and serum GPCA positivity than healthy control subjects and significantly higher frequencies of anemia, serum vitamin B12 and folic acid deficiencies, and serum GPCA positivity than AG patients without hyperhomocysteinemia.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Atrophy; Autoantibodies; Case-Control Studies; Erythrocyte Count; Erythrocyte Indices; Female; Folic Acid; Glossitis; Hemoglobins; Humans; Hyperhomocysteinemia; Iron; Male; Middle Aged; Parietal Cells, Gastric; Taiwan; Vitamin B 12; Young Adult

Nutritional B12 deficiency is a treatable cause of neurodevelopmental delay in infants. We report 21 infants with developmental regression and brain atrophy as revealed using cranial magnetic resonance imaging (MRI), secondary to severe vitamin B12 deficiency.. Twenty-one infants aged 4-24 months with B12 deficiencies who were admitted to our clinic between May 2013 and May 2018 were included in the study. MRI, bone marrow aspiration and the Denver-II Developmental Screening Test were performed in all infants.. The mean age of the infants was 12.3 months, and the mean B12 level was 70.15 ± 32.15 ng/L. Hypotonia and neurodevelopmental retardation, and anaemia were present in all patients. Their bone marrow examinations were compatible with megaloblastic anaemia. Twelve patients had microcephaly, seven had tremor and one patient died of severe sepsis. Almost all patients were fed with breast milk and their mothers were also malnourished. Nine (42.9%) of the patients were Turkish and 12 (57.1%) were Syrian. All patients had abnormal Denver-II Developmental Screening Test scores. Most patients had severe cortical atrophy, cerebral effusion, thinning of the corpus callosum and delayed myelinisation in cranial MRI. Treatment with B12 resulted in dramatic improvement in general activity and appetite within 72 h. Tremors resolved in all cases.. Neurological findings and developmental delay related to nutritional B12 deficiency can be prevented without sequelae if diagnosed early. Screening and treating of mothers for this deficiency will contribute to the health of both the mother and their feeding infant.

Topics: Atrophy; Child, Preschool; Female; Humans; Infant; Magnetic Resonance Imaging; Mothers; Muscle Hypotonia; Vitamin B 12; Vitamin B 12 Deficiency

Dementia, and in particular Alzheimer's disease (AD), is a debilitating progressive disease with high prevalence in our society. Vitamin B12 and folate deficiency are potential modifiable risk factors. However, previous studies reported inconsistent results.. The average concentrations of all biochemical markers were within the respective reference ranges. Cross-sectional and longitudinal analyses did not reveal significant associations between biochemical markers and cognitive function, global or regional brain volume, cortical thickness or cortical surface area, neither in controls nor in AD patients.. Variations of direct and indirect markers of B12 and folate status are not associated with cognitive dysfunction and brain atrophy.. This retrospective study explored the association between biochemical markers of B12 and folate status, cognitive function and MRI-based brain atrophy in cognitive normal elderly (controls) and AD patients. Folate, total and active vitamin B12 and MMA were measured in blood samples from 378 controls and 217 AD patients. Neuropsychiatric tests capturing memory, executive function and visuopractical skills were performed in all participants. Brain atrophy was assessed by MRI in 155 controls and 217 AD patients. In a subset of participants cognitive testing (n=234) and MRI (n=182) was repeated after an average median between 1.25 and 6.25 years.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Atrophy; Austria; Brain; Cognition; Cohort Studies; Female; Folic Acid; Humans; Male; Middle Aged; Retrospective Studies; Vitamin B 12

Our previous study found 284 gastric parietal cell antibody (GPCA)-positive atrophic glossitis (AG) patients (so-called GPCA. Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 117 high-titer GPCA. We found that 12.0%, 29.1%, 23.1%, 16.2%, 1.7%, and 23.1% of 117 high-titer GPCA. For GPCA

Topics: Adult; Aged; Aged, 80 and over; Anemia, Macrocytic; Atrophy; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Glossitis; Hemoglobins; Homocysteine; Humans; Hyperhomocysteinemia; Iron; Male; Middle Aged; Parietal Cells, Gastric; Tongue; Vitamin B 12; Vitamin B 12 Deficiency

As a worldwide infectious bacterium,. This study has been conducted on 289 patients who have met the inclusion criteria. Within these patients, 213 of them were. In conclusion, B12 deficiency was positively correlated with CagA positivity and gastric inflammatory activity.

Topics: Adolescent; Adult; Aged; Antigens, Bacterial; Atrophy; Bacterial Proteins; Female; Gastric Mucosa; Helicobacter Infections; Helicobacter pylori; Humans; Male; Middle Aged; Stomach; Stomach Neoplasms; Virulence Factors; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Approximately 27% of atrophic glossitis (AG) patients have the serum gastric parietal cell antibody (GPCA) positivity. This study assessed whether the serum GPCA or AG itself was a significant factor causing anemia, hematinic deficiencies, and hyperhomocysteinemia in GPCA-positive AG (GPCA. The mean corpuscular volume (MCV) and mean blood hemoglobin (Hb), iron, vitamin B12, folic acid, and homocysteine levels were measured and compared between any two of three groups of 284 GPCA. Both 284 GPCA. The disease of AG itself is a significant factor causing anemia, hematinic deficiencies, and hyperhomocysteinemia in both GPCA

Topics: Adult; Aged; Aged, 80 and over; Anemia; Atrophy; Autoantibodies; Case-Control Studies; Erythrocyte Count; Erythrocyte Indices; Female; Folic Acid; Glossitis; Hemoglobins; Humans; Hyperhomocysteinemia; Iron; Male; Middle Aged; Parietal Cells, Gastric; Taiwan; Vitamin B 12; Young Adult

Our previous study found that 177 of 1064 atrophic glossitis (AG) patients have serum gastric parietal cell antibody (GPCA) positivity only (so-called GPCA. The mean blood hemoglobin (Hb), iron, vitamin B12, folic acid, and homocysteine levels were measured and compared between any two of three groups of 177 GPCA. GPCA. The GPCA is a major factor causing vitamin B12 deficiency and hyperhomocyteinemia in GPCA

Topics: Adult; Aged; Aged, 80 and over; Anemia; Atrophy; Autoantibodies; Erythrocyte Indices; Female; Folic Acid; Glossitis; Hemoglobins; Humans; Hyperhomocysteinemia; Iron; Male; Middle Aged; Parietal Cells, Gastric; Taiwan; Vitamin B 12; Young Adult

Microcytosis is defined as having mean corpuscular volume (MCV) < 80 fL. This study evaluated whether 79 atrophic glossitis (AG) patients with microcytosis and 985 AG patient without microcytosis had higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than 532 healthy control subjects.. Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and serum GPCA levels in 79 AG patients with microcytosis, 985 AG patient without microcytosis, and 532 healthy control subjects were measured and compared.. We found that 69.6%, 43.0%, 5.1%, 3.8%, 11.4%, and 22.8% of 79 AG patients with microcytosis and 14.9%, 14.8%, 5.3%, 2.1%, 12.0%, and 27.0% of 985 AG patients without microcytosis were diagnosed as having blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Both 79 AG patients with microcytosis and 985 AG patients without microcytosis had significantly higher frequencies of blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 532 healthy control subjects (all P-values < 0.01). Moreover, 79 AG patients with microcytosis had significantly higher frequencies of blood hemoglobin and iron deficiencies than 985 AG patients without microcytosis.. There are significantly higher frequencies of anemia, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity in AG patients with or without microcytosis than in healthy control subjects. AG patients with microcytosis have significantly higher frequencies of blood hemoglobin and iron deficiencies than AG patients without microcytosis.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Atrophy; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Erythropoiesis; Female; Folic Acid; Folic Acid Deficiency; Glossitis; Hemoglobins; Homocysteine; Humans; Hyperhomocysteinemia; Iron; Iron Deficiencies; Male; Middle Aged; Parietal Cells, Gastric; Tongue; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Macrocytosis is defined as having the mean corpuscular volume (MCV) ≧ 100 fL. This study evaluated whether 41 atrophic glossitis (AG) patients with macrocytosis had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity than 532 healthy control subjects or 1064 AG patients.. Complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and GPCA levels in 41 AG patients with macrocytosis, 1064 AG patients, and 532 healthy control subjects were measured and compared.. We found that 73.2%, 22.0%, 73.2%, 4.9%, 80.5%, and 56.1% of 41 AG patients with macrocytosis were diagnosed as having blood hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Moreover, 41 AG patients with macrocytosis had significantly higher frequencies of blood hemoglobin and serum vitamin B12 deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 532 healthy control subjects or 1064 AG patients (all P-values < 0.001). In addition, 41 AG patients with macrocytosis also had significantly higher frequencies of serum iron and folic acid deficiencies than 532 healthy control subjects (both P-values < 0.001). Pernicious anemia was found in 22 AG patients with macrocytosis.. There are significantly higher frequencies of anemia and serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity in AG patients with macrocytosis than in healthy control subjects. AG patients with macrocytosis also have significantly higher frequencies of blood hemoglobin and serum vitamin B12 deficiencies, hyperhomocysteinemia, and serum GPCA positivity than AG patients.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Anemia, Macrocytic; Atrophy; Autoantibodies; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Glossitis; Hematinics; Hematologic Diseases; Hemoglobins; Homocysteine; Humans; Hyperhomocysteinemia; Iron; Male; Middle Aged; Parietal Cells, Gastric; Tongue; Vitamin B 12; Young Adult

Topics: Atrophy; Brain; Humans; Vitamin B 12; Vitamin B 12 Deficiency

The Cobalamin C deficiency (cblC), characterized with elevated methylmalonic acidemia and homocystinuria in plasma, is an inborn error of cobalamin metabolism. The late-onset cblC siblings patients were rarely reported. In this study, we analyzed the clinical presentations and treatment outcomes of late-onset cblC in Chinese sibling patients with neuropsychiatric presentations. The clinical data of four pairs of Chinese patients were retrospectively analyzed. Serum homocysteine, urine organic acids measurements, neuroimaging exams and gene analysis were carried out in all patents. Patients were reevaluated after treatments with cobalamin, folate, betaine, L-carnitine and compound vitamin B. The mean age at disease onset was 13.7 (range 2-19) years. The neuropsychiatric disturbances including cognitive decline (3/8), psychiatric disturbances (4/8), gait instability (2/8), lower extremity weakness and numbness (3/8) and thromboembolic events (1/8). Two patients suffered nephropathy. The mean serum homocysteine when patients were diagnosed was 109.4 (range 69.5-138) μM/L. The abnormal radioimaging included scoliosis by X-ray (5/6), cerebral atrophy (4/6) and spinal cord atrophy (3/6) by MRI scan. Three pairs of siblings showed heterozygous mutations of MMACHC gene including c.482G > A (4/6), c.354G > C (2/6), c.570insT (2/6), c.445_446del (2/6) and c.656_4658del (2/6). The other two siblings showed homozygous mutation with c.452A > G in MMACHC gene. After treatments, the psychiatric symptoms were obviously relieved in all the patients. In Chinese siblings with late-onset cblC, the main clinic manifestation and abnormal radioimaging were cognitive decline and cerebral atrophy respectively. The most common gene mutation was c.482G > A of MMACHC gene. The patients responded well to the treatments.

Topics: Adolescent; Adult; Asian People; Atrophy; Brain; Brain Diseases; Carrier Proteins; Child; Child, Preschool; Female; Genetic Testing; Homocystinuria; Humans; Male; Methylmalonic Acid; Mutation; Phenotype; Siblings; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Atrophic glossitis (AG) patients are prone to have anemia, hematinic deficiencies, hyperhomocysteinemia, and serum gastric parietal cell antibody (GPCA) positivity. This study evaluated whether 1064 AG patients had significantly higher frequencies of anemia, hematinic deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 532 healthy control subjects.. The complete blood count, serum iron, vitamin B12, folic acid, homocysteine, and serum GPCA levels in 1064 AG patients and 532 age- and sex-matched healthy control subjects were measured and compared.. We found that 7.4%, 3.9%, 19.0%, 16.9%, 5.3%, 2.3%, 11.9%, and 26.7% of 1064 AG patients were diagnosed as having microcytosis, macrocytosis, hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity, respectively. Moreover, 1064 AG patients had significantly higher frequencies of microcytosis, macrocytosis, hemoglobin, iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity than 532 healthy control subjects (all P-values < 0.005). Of the 202 anemic AG patients, 22 had pernicious anemia, eight had macrocytic anemia rather than pernicious anemia, 117 had normocytic anemia, 30 had iron deficiency anemia, and 21 had thalassemia trait-induced anemia, and four had microcytic anemia rather than iron deficiency anemia and thalassemia trait-induced anemia.. There are significantly higher frequencies of anemia, serum iron, vitamin B12, and folic acid deficiencies, hyperhomocysteinemia, and serum GPCA positivity in AG patients than in healthy control subjects. The normocytic anemia and iron deficiency anemia are the two most common types of anemia in our 1064 AG patients.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Atrophy; Autoantibodies; Case-Control Studies; Erythrocyte Count; Erythrocyte Indices; Female; Folic Acid; Glossitis; Hemoglobins; Humans; Hyperhomocysteinemia; Iron; Male; Middle Aged; Parietal Cells, Gastric; Taiwan; Vitamin B 12; Young Adult

To report five cases of subacute combined degeneration (SCD) with brain involvement and explore its clinical and imaging characteristics.. A retrospective study was performed on the clinical data and brain MRI of five patients with subacute combined degeneration with brain involvement (out of 107 cases with SCD in total). White matter lesions (WML) assessment was performed qualitatively using Fazekas scale score.. The main symptoms in four patients were weakness in both lower extremities and unstable walking (limb weakness in three patients, dizziness in three patients, and blurred vision in one patient). One patient had memory loss and cognitive dysfunction. The MMSE scale indicated mild dementia in one patient. On head MRI (Magnetic Resonance Imaging), multifocal and symmetrical high signals of T2WI and FLAIR were observed in the frontal lobe and periventricular white matter in four patients, while another patient showed preferential atrophy in frontal regions. Fazekas scale scores ranged from 1-6.. Adult subacute combined degeneration seldom involves the brain. Multifocal and symmetrical high signal white matter lesions can be found on FLAIR and T2WI, as well as frontal atrophy on head MRI.

Topics: Aged; Atrophy; Cognition Disorders; Female; Homocysteine; Humans; Leukoencephalopathies; Magnetic Resonance Imaging; Male; Mental Status Schedule; Middle Aged; Retrospective Studies; Subacute Combined Degeneration; Vitamin B 12

Vitamin B12, folate, and sulfur amino acids may be modifiable risk factors for structural brain changes that precede clinical dementia.. To investigate the association of circulating levels of vitamin B12, red blood cell folate, and sulfur amino acids with the rate of total brain volume loss and the change in white matter hyperintensity volume as measured by fluid-attenuated inversion recovery in older adults.. The magnetic resonance imaging subsample of the Swedish National Study on Aging and Care in Kungsholmen, a population-based longitudinal study in Stockholm, Sweden, was conducted in 501 participants aged 60 years or older who were free of dementia at baseline. A total of 299 participants underwent repeated structural brain magnetic resonance imaging scans from September 17, 2001, to December 17, 2009.. The rate of brain tissue volume loss and the progression of total white matter hyperintensity volume.. In the multi-adjusted linear mixed models, among 501 participants (300 women [59.9%]; mean [SD] age, 70.9 [9.1] years), higher baseline vitamin B12 and holotranscobalamin levels were associated with a decreased rate of total brain volume loss during the study period: for each increase of 1 SD, β (SE) was 0.048 (0.013) for vitamin B12 (P < .001) and 0.040 (0.013) for holotranscobalamin (P = .002). Increased total homocysteine levels were associated with faster rates of total brain volume loss in the whole sample (β [SE] per 1-SD increase, -0.035 [0.015]; P = .02) and with the progression of white matter hyperintensity among participants with systolic blood pressure greater than 140 mm Hg (β [SE] per 1-SD increase, 0.000019 [0.00001]; P = .047). No longitudinal associations were found for red blood cell folate and other sulfur amino acids.. This study suggests that both vitamin B12 and total homocysteine concentrations may be related to accelerated aging of the brain. Randomized clinical trials are needed to determine the importance of vitamin B12 supplementation on slowing brain aging in older adults.

Topics: Aged; Alzheimer Disease; Amino Acids, Sulfur; Atrophy; Brain; Female; Folic Acid; Homocysteine; Humans; Linear Models; Longitudinal Studies; Magnetic Resonance Imaging; Male; Middle Aged; Risk Factors; Statistics as Topic; Sweden; Vitamin B 12; White Matter

Hyperhomocysteinemia may be involved in the development of brain atrophy in alcoholics. Its pathogenesis is multifactorial. In the present study, we analyse the relationship between homocysteine levels and brain atrophy, and the relative weight of co-existing factors such as liver function impairment, the amount of ethanol consumed, serum vitamin B12, B6, and folic acid levels on homocysteine levels and brain alterations in alcoholic patients.. We included 59 patients admitted to this hospital for major withdrawal symptoms and 24 controls. The mini-mental state examination test and a brain computed tomography (CT) scan were performed and several indices were calculated. Serum levels of homocysteine, folic acid, vitamin B6 and vitamin B12 were determined. Liver function was assessed by Child-Pugh score. The daily consumption of ethanol in grams per day and years of addiction were recorded.. A total of 83.6% and 80% of the patients showed cerebellar or frontal atrophy, respectively. Patients showed altered values of brain indices, higher levels of homocysteine and vitamin B12, but lower levels of folic acid, compared with controls. Homocysteine, B12 and liver function variables showed significant correlations with brain CT indices. Multivariate analyses disclosed that Pugh's score, albumin and bilirubin were independently related to cerebellar atrophy, frontal atrophy, cella index or ventricular index. Serum vitamin B12 was the only factor independently related to Evans index. It was also related to cella index, but after bilirubin. Homocysteine levels were independently related to ventricular index, but after bilirubin.. Vitamin B12 and homocysteine levels are higher among alcoholics. Liver function derangement, vitamin B12 and homocysteine are all independently related to brain atrophy, although not to cognitive alterations.. Hyperhomocysteinemia has been described in alcoholics and may be related to brain atrophy, a reversible condition with an obscure pathogenesis. We studied 59 patients and found that liver function derangement, vitamin B12 and homocysteine levels are all independently related to brain atrophy assessed by computed tomography, although we found no association between these parameters and cognitive alterations.

Topics: Alcoholism; Atrophy; Brain; Case-Control Studies; Female; Folic Acid; Homocysteine; Humans; Liver; Male; Middle Aged; Tomography, X-Ray Computed; Vitamin B 12; Vitamin B 6

We examined whether using a medical food therapy for hyperhomocysteinemia (HHcy) in patients with Alzheimer's disease (AD) or cognitive impairment due to cerebrovascular disease (CVD) with Cerefolin®/CerefolinNAC® (CFLN: L-methylfolate, methylcobalamin, and N-acetyl-cysteine) slowed regional brain atrophy. Thirty HHcy patients with AD and related disorders (ADRD) received CFLN (HHcy+CFLN: duration [μ ±  σ] = 18.6±16.1 months); a sub-sample of this group did not receive CFLN for varying periods of time (HHcy+NoCFLN: duration [μ ±  σ] = 12.6±5.6 months). Thirty-seven NoHHcy patients with ADRD did not receive CFLN (NoHHcy+NoCFLN: duration [μ ±  σ] = 13.3±17.7 months). No participant took supplemental B vitamins. Regional brain volumes were measured at baseline and end of study, and covariate-adjusted rates of hippocampal, cortical, and forebrain parenchymal (includes white matter) atrophy were predicted. The HHcy+CFLN group's hippocampal and cortical atrophy adjusted rates were 4.25 and 11.2 times slower than those of the NoHHcy+NoCFLN group (p < 0.024). The HHcy+CFLN group's forebrain parenchyma atrophy rate was significantly slower only for CVD; the rate of slowing was proportional to the degree of homocysteine lowering (p < 0.0001). CFLN was associated with significantly slowed hippocampal and cortical atrophy rates in ADRD patients with HHcy, and forebrain parenchymal atrophy rates in CVD patients with HHcy. The present results should be further validated.

Topics: Acetylcysteine; Aged; Aged, 80 and over; Alzheimer Disease; Atrophy; Cerebral Cortex; Cerebrovascular Disorders; Dietary Supplements; Female; Humans; Hyperhomocysteinemia; Male; Middle Aged; Tetrahydrofolates; Vitamin B 12; Vitamin B Complex; White Matter

Some of recurrent aphthous stomatitis (RAS) patients had concomitant atrophic glossitis (AG). This study assessed whether RAS patients with AG (AG+/RAS patients) or without AG (AG-/RAS patients) had anemia and hematinic deficiencies and to evaluate whether RAS combined with AG or RAS itself was a significant factor causing anemia and hematinic deficiencies in AG+/RAS or AG-/RAS patients, respectively.. The mean corpuscular volume (MCV) and mean blood hemoglobin (Hb), iron, vitamin B12, and folic acid levels were measured and compared between any two of three groups of 160 AG+/RAS patients, 195 AG-/RAS patients, and 355 healthy control subjects.. Both AG+/RAS and AG-/RAS patients had significantly lower mean Hb, iron, and vitamin B12 levels as well as significantly greater frequencies of Hb, iron, vitamin B12, and folic acid deficiencies than healthy control subjects. Moreover, AG+/RAS patients had significantly lower mean Hb and serum iron level (for women only) and significantly greater frequencies of Hb and iron deficiencies than AG-/RAS patients. Of 69 anemia AG+/RAS patients, 30 (43.5%) had normocytic anemia and 23 (33.3%) had iron deficiency anemia. Of 38 anemia AG-/RAS patients, 26 (68.4%) had normocytic anemia and 5 (13.2%) had iron deficiency anemia.. We conclude that some of AG+/RAS or AG-/RAS patients do have anemia and hematinic deficiencies and AG+/RAS patients do have severer anemia statuses and iron deficiency than AG-/RAS patients. RAS combined with AG or RAS itself does play a significant role in causing anemia and hematinic deficiencies in AG+/RAS or AG-/RAS patients, respectively.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anemia; Anemia, Iron-Deficiency; Atrophy; Case-Control Studies; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Glossitis; Hematinics; Hemoglobins; Humans; Iron; Male; Middle Aged; Recurrence; Risk Factors; Stomatitis, Aphthous; Tongue; Vitamin B 12; Vitamin B 12 Deficiency; Young Adult

Classical (or isolated) methylmalonic acidemia (MMA) is a heterogeneous inborn error of metabolism most typically caused by mutations in the vitamin B12-dependent enzyme methylmalonyl-CoA mutase (MUT). With the improved survival of individuals with MMA, chronic kidney disease has become recognized as part of the disorder. The precise description of renal pathology in MMA remains uncertain.. Light microscopy, histochemical, and ultrastructural studies were performed on the native kidney obtained from a 19-year-old patient with mut MMA who developed end stage renal disease and underwent a combined liver-kidney transplantation.. The light microscopy study of the renal parenchyma in the MMA kidney revealed extensive interstitial fibrosis, chronic inflammation, and tubular atrophy. Intact proximal tubules were distinguished by the widespread formation of large, circular, pale mitochondria with diminished cristae. Histochemical preparations showed a reduction of cytochrome c oxidase and NADH activities, and the electron microscopy analysis demonstrated loss of cytochrome c enzyme activity in these enlarged mitochondria.. Our results demonstrate that the renal pathology of MMA is characterized by megamitochondria formation in the proximal tubules in concert with electron transport chain dysfunction. Our findings suggest therapies that target mitochondrial function as a treatment for the chronic kidney disease of MMA.

Topics: Amino Acid Metabolism, Inborn Errors; Atrophy; Diet, Protein-Restricted; Female; Humans; Kidney; Kidney Diseases; Kidney Tubules, Proximal; Metabolism, Inborn Errors; Methylmalonyl-CoA Mutase; Mitochondria; Mitochondrial Diseases; Nephritis; Vitamin B 12; Young Adult

In developed countries, vitamin B12 (cobalamin) deficiency usually occurs in children, exclusively breastfed ones whose mothers are vegetarian, causing low body stores of vitamin B12. The haematologic manifestation of vitamin B12 deficiency is pernicious anaemia. It is a megaloblastic anaemia with high mean corpuscular volume and typical morphological features, such as hyperlobulation of the nuclei of the granulocytes. In advanced cases, neutropaenia and thrombocytopaenia can occur, simulating aplastic anaemia or leukaemia. In addition to haematological symptoms, infants may experience weakness, fatigue, failure to thrive, and irritability. Other common findings include pallor, glossitis, vomiting, diarrhoea, and icterus. Neurological symptoms may affect the central nervous system and, in severe cases, rarely cause brain atrophy. Here, we report an interesting case, a 12-month old infant, who was admitted with neurological symptoms and diagnosed with vitamin B12 deficiency.

Topics: Anemia, Macrocytic; Atrophy; Breast Feeding; Cerebral Cortex; Diet, Vegetarian; Humans; Infant; Magnetic Resonance Imaging; Male; Mothers; Treatment Outcome; Turkey; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Topics: Atrophy; Developmental Disabilities; Female; Fever; Homocysteine; Humans; Infant; Muscle Hypotonia; Neuroimaging; Seizures; Vitamin B 12; Vitamin B 12 Deficiency

Patients with thalassemia trait (TT) may have anemia. This study evaluated whether TT patients had specific oral manifestations and a particular blood profile compared with normal individuals.. The oral manifestations and mean red blood cell count, corpuscular cell volume, red blood cell distribution width, Mentzer index, and Green and King index as well as blood concentrations of hemoglobin, iron, total iron binding capacity, vitamin B12, folic acid, and homocysteine in 65 TT patients and in 130 age- and sex-matched healthy controls were measured and compared.. TT patients had significantly higher frequencies of all oral manifestations than healthy controls (p < 0.001 for all), in which burning sensation of oral mucosa (90.8%), lingual varicosity (90.8%), dry mouth (72.3%), atrophic glossitis (32.3%), and numbness of the oral mucosa (30.8%) were the five leading oral manifestations for TT patients. Moreover, TT patients had significantly lower mean hemoglobin level, corpuscular cell volume, Mentzer index, and Green and King index (p < 0.001 for all) as well as significantly higher mean red blood cell count and red blood cell distribution width (p < 0.001 for both) than healthy controls. However, no significant difference in the mean blood iron, total iron binding capacity, vitamin B12, folic acid, or homocysteine levels was discovered between 65 TT patients and 130 healthy controls.. TT patients have specific oral manifestations and a particular blood profile compared to normal individuals.

Topics: Adult; Aged; Aged, 80 and over; Atrophy; Case-Control Studies; Erythrocyte Count; Erythrocyte Indices; Female; Folic Acid; Glossitis; Hemoglobins; Homocysteine; Humans; Hypesthesia; Iron; Male; Middle Aged; Mouth Mucosa; Thalassemia; Tongue; Varicose Veins; Vitamin B 12; Xerostomia; Young Adult

Seizures and epilepsy are a common problem in childhood. Nonepileptic paroxysmal events are conditions that can mimic seizure and frequent in early childhood. Nonepileptic paroxysmal events can be due to physiological or exaggerated physiological responses, parasomnias, movement disorders, behavioral or psychiatric disturbances, or to hemodynamic, respiratory, or gastrointestinal dysfunction. Vitamin B12 deficiency is a treatable cause of failure to thrive and developmental regression, involuntary movements, and anemia. Involuntary movements rarely may appear a few days after the initiation of vitamin B12 treatments and might be misdiagnosed as seizure. Here, we report 2 patients who presented with involuntary movements with his video image.

Topics: Atrophy; Brain; Breast Feeding; Clonazepam; Diagnostic Errors; Dyskinesia, Drug-Induced; Electroencephalography; Emergencies; Epilepsies, Partial; Female; Growth Disorders; Humans; Infant; Injections, Intramuscular; Magnetic Resonance Imaging; Male; Milk, Human; Psychomotor Agitation; Status Epilepticus; Vitamin B 12; Vitamin B 12 Deficiency

This study evaluated whether supplementations of different vitamins and iron could reduce the serum homocysteine levels in 91 atrophic glossitis (AG) patients.. Atrophic glossitis (AG) patients with concomitant deficiencies of vitamin B12 only (n = 39, group I), folic acid only (n = 10, group II), iron only (n = 9, group III), or vitamin B12 plus iron (n = 19, group IV) were treated with vitamin BC capsules plus deficient hematinics. AG patients without definite hematinic deficiencies (n = 14, group V) were treated with vitamin BC capsules only. The blood homocysteine and hematinic levels at baseline and after treatment till all oral symptoms had disappeared were measured and compared by paired t-test.. Supplementations with vitamin BC capsules plus corresponding deficient hematinics for groups I, II, III, IV patients and with vitamin BC capsules only for group V patients could reduce the high serum homocysteine levels to significantly lower levels after a mean treatment period of 8.3-11.6 months (all P-values < 0.05).. Supplementations with vitamin BC capsules plus corresponding deficient hematinics or with vitamin BC capsules only can reduce the high serum homocysteine levels to significantly lower levels in AG patients.

Topics: Adult; Aged; Aged, 80 and over; Atrophy; Dietary Supplements; Female; Folic Acid; Glossitis; Hematinics; Homocysteine; Humans; Iron; Male; Middle Aged; Tongue; Vitamin B 12; Vitamin B Complex; Young Adult

Involuntary movements can appear before and after initiation of vitamin B12 treatment. The pathogenesis of involuntary movements in vitamin B12 deficiency and their relationship with cobalamin injection remain unclear due to a lack of video-EEG documentation making the electroclinical correlation difficult to ascertain. Here, we report video-EEG and neuroimaging findings of an 11-month-old girl with vitamin B12 deficiency, who acutely developed involuntary movements a few days after initiation of vitamin B12 treatment with normal vitamin plasmatic levels. Abnormal movements were a combination of tremor and myoclonus involving the face, mouth, and left arm, which disappeared after discontinuation of therapy. [Published with video sequences].

Topics: Atrophy; Brain; Dyskinesias; Electroencephalography; Female; Humans; Infant; Magnetic Resonance Imaging; Myelin Sheath; Myoclonus; Tremor; Video Recording; Vitamin B 12; Vitamin B 12 Deficiency; Vitamins

Increased serum homocysteine and low folate levels are associated with a higher rate of conversion to dementia. This study examined the influence of vitamin B12/folic acid intake on the conversion from mild cognitive impairment (MCI) to dementia.. A community dwelling cohort of older adults (N=81) from the Vienna Transdanube aging study with MCI.. Prospective study with a retrospective evaluation of vitamin intake.. Laboratory measurements, brain magnetic resonance imaging, and cognitive functioning were assessed at baseline and at five-year follow-up.. The self-reported combined use of folic acid and vitamin B12 for more than one year was associated with a lower conversion rate to dementia. Serum levels of homocysteine and vitamin B12 as measured at baseline or at five years were not associated with conversion. Higher folate levels at baseline in females predicted a lower conversion rate to dementia. The assessment of brain morphological parameters by magnetic resonance imaging revealed higher serum folate at baseline, predicting lower medial temporal lobe atrophy and higher levels of homocysteine at baseline, predicting moderate/severe global brain atrophy at five years. Users of vitamin B12 or folate, independent of time and pattern of use, had lower grades of periventricular hyperintensities and lower grades of deep white matter lesions as compared to non-users.. These results from a middle European study support observations on the protective ability of folate in MCI patients with respect to conversion to dementia; they also point to a participation of homocysteine metabolism on processes associated with brain atrophy.

Topics: Aged; Aging; Atrophy; Austria; Brain; Cognitive Dysfunction; Cohort Studies; Dementia; Dietary Supplements; Disease Progression; Female; Folic Acid; Follow-Up Studies; Humans; Hyperhomocysteinemia; Longitudinal Studies; Male; Prospective Studies; Retrospective Studies; Vitamin B 12

Vitamin B12 deficiency in infants often presents with nonspecific hematological, gastrointestinal, and neurological manifestations. It is usually caused by inadequate intake, abnormal absorption, or congenital disorders of vitamin B12 metabolism, including transport disorders. We describe a vitamin B12-deficient infant with severe anemia who was breastfed. His mother had undiagnosed vitamin B12 deficiency having undergone total gastrectomy 18 years earlier. The infant developed normally after taking vitamin B12. It is important to suspect vitamin B12 deficiency in mothers who have undergone gastrectomy. Early diagnosis and treatment of vitamin B12 deficiency in infants is important and will help improve long-term prognosis.

Topics: Anemia, Megaloblastic; Atrophy; Brain; Humans; Infant; Male; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

To investigate the relationship between markers of vitamin B(12) status and brain volume loss per year over a 5-year period in an elderly population.. A prospective study of 107 community-dwelling volunteers aged 61 to 87 years without cognitive impairment at enrollment. Volunteers were assessed yearly by clinical examination, MRI scans, and cognitive tests. Blood was collected at baseline for measurement of plasma vitamin B(12), transcobalamin (TC), holotranscobalamin (holoTC), methylmalonic acid (MMA), total homocysteine (tHcy), and serum folate.. The decrease in brain volume was greater among those with lower vitamin B(12) and holoTC levels and higher plasma tHcy and MMA levels at baseline. Linear regression analysis showed that associations with vitamin B(12) and holoTC remained significant after adjustment for age, sex, creatinine, education, initial brain volume, cognitive test scores, systolic blood pressure, ApoE epsilon4 status, tHcy, and folate. Using the upper (for the vitamins) or lower tertile (for the metabolites) as reference in logistic regression analysis and adjusting for the above covariates, vitamin B(12) in the bottom tertile (<308 pmol/L) was associated with increased rate of brain volume loss (odds ratio 6.17, 95% CI 1.25-30.47). The association was similar for low levels of holoTC (<54 pmol/L) (odds ratio 5.99, 95% CI 1.21-29.81) and for low TC saturation. High levels of MMA or tHcy or low levels of folate were not associated with brain volume loss.. Low vitamin B(12) status should be further investigated as a modifiable cause of brain atrophy and of likely subsequent cognitive impairment in the elderly.

Topics: Aged; Aged, 80 and over; Atrophy; Biomarkers; Brain; Female; Humans; Longitudinal Studies; Male; Middle Aged; Organ Size; Prospective Studies; Residence Characteristics; Time Factors; Vitamin B 12; Vitamin B 12 Deficiency

The changes of plasma amyloid beta (Abeta42) protein, homocysteine and medial temporal lobe atrophy (MTA) were studied by the transition from cognitive health to mild cognitive impairment (MCI) and to Alzheimer's disease (AD) in a prospective cohort of individuals aged 75 years. MTA but not plasma Abeta42 measured at baseline predicted which persons remained cognitively healthy (CH) and who developed AD 2.5 years later. The increase of plasma Abeta42 over time significantly distinguished between persons who remained CH on the one hand and MCI converters and AD converters out of cognitive health on the other (CH-to-MCI and CH-to-AD converters). Although both groups showed similar increase of Abeta42 levels, CH-to-AD converters had a higher increase of homocysteine compared to CH-to-MCI converters or to persons remaining CH. In comparison to all cognitive subgroups, the AD converters from MCI at baseline showed the smallest increase of Abeta42 levels and rather no increase of homocysteine. In logistic regression analysis, the increase of plasma Abeta42 but not change of MTA significantly predicted the conversion from CH to MCI, and changes of MTA and homocysteine but not of plasma Abeta42 predicted the conversion from CH to AD. The increase of plasma Abeta42 correctly allocated CH-to-MCI and CH-to-AD converters with low (63%) specificity (for both) and low (60%) sensitivity (54% for AD group). These results indicate that (1) plasma Abeta42 alone is not suitable as a biomarker for AD, (2) in the course of cognitive deterioration of the AD-type the increase of plasma Abeta42 seems to be an initial event, (3) similar to cerebrospinal fluid, changes of plasma Abeta42 may reflect the transition from cognitive health to AD, and (4) whether persons with MCI develop AD may depend on an accumulation of further toxic metabolites such as homocysteine.

Topics: Aged; Alzheimer Disease; Amyloid beta-Peptides; Apolipoproteins E; Atrophy; Cognition Disorders; Cohort Studies; Disease Progression; Female; Folic Acid; Homocystine; Humans; Logistic Models; Magnetic Resonance Imaging; Male; Neuropsychological Tests; Peptide Fragments; Predictive Value of Tests; Psychometrics; Retrospective Studies; Temporal Lobe; Vitamin B 12

We aimed to analyze morphometric features of the small-bowel mucosa in children with celiac disease, to assess the diagnostic limit values of morphometric findings, and to examine the association of morphometric findings with the clinical presentation and laboratory findings. The study comprised 33 patients with celiac disease and 35 pediatric patients undergoing endoscopy for other causes. Biopsy specimens were reanalyzed for (1) intraepithelial lymphocytes, (2) goblet cells, (3) villous height, and (4) villous/crypt ratio. The morphometric parameters of the patients were compared with controls. Then celiac patients were divided into two groups according to the presence of total villous atrophy and clinical and laboratory findings were compared. Histologic examination revealed that goblet cells, villus height, and villous/crypt ratio were significantly lower and intraepithelial lymphocytes were significantly higher in celiac patients. Cutoff values for intraepithelial lymphocytes and goblet cells in celiac patients were 31/100 and 7.8/100 epithelial cells, respectively. Moreover, for villus height and villous/crypt ratio, cutoff values were 633 microm and 0.72, respectively. Serum folic acid and vitamin B(12) levels were significantly lower in patients with total villous atrophy and were positively correlated with the severity of villous atrophy. We suggest that morphologic examination and laboratory data are important for definitive diagnosis. Villous/crypt ratio is the most sensitive and specific parameter, and intraepithelial lymphocytes may be used along with villous/crypt ratio, especially in the early phase. Folic acid and vitamin B(12) levels are good indicators of villous atrophy.

Topics: Atrophy; Biomarkers; Celiac Disease; Child; Child, Preschool; Endoscopy, Gastrointestinal; Female; Folic Acid; Humans; Infant; Intestinal Mucosa; Intestine, Small; Luminescent Measurements; Male; Prevalence; Severity of Illness Index; Turkey; Vitamin B 12

The newborn's vitamin B12 storage exclusively comes from placenta transfer, later from animal food. We relate 3 observations of infants (3-11-13 months) with failure to thrive, anorexia, vomiting and for the two olders refusal of weaning, associated with psychomotricity regression and hypotony. Blood cell count showed a macrocytosis without anemia (case 2-3) and a severe microcytic anemia for the first case caused by a mild alpha-thalassemia, with megaloblastic bone marrow. Vitamin B12 levels were very low associated with increased methylmalonic acid and homocysteine serum levels which confirm the diagnostic . Cerebral imaging showed diffuse cortical atrophy. Cobalamin deficiency was caused by strict vegetarian diets mothers of breastfed infants (cases 2-3) and for younger by mother's unrecognized pernicious anemia. 3 mothers had no anemia and normal B12 's levels at diagnosis. Vitamin B12 supply lead to a rapid clinical and hematologic improvement. In two cases, neurologic recovery was incomplete. About one hundred case of B12 deficiency 's infant are reported, 2/3 are breast-fed by vegetarian mothers, and 1/4 have mothers with pernicious anemia. The failure to thrive is due to anorexia, refusal of weaning and partial villous atrophy. Neurologic manifestations are secondary to cerebral disorders, sometimes revealed by an exposure to anesthetic nitrous oxyd. The macrocytic anemia is inconstant. The etiologic research of developmental delay in an infant may include vitamin B12's deficiency, even if there is no haematologic signs, especially if breast-fedding 's mothers is vegetarian.

Topics: Atrophy; Brain; Failure to Thrive; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Psychomotor Disorders; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex; Vomiting

A 20-month-old German shepherd with primary pancreatic acinar atrophy and exocrine pancreatic insufficiency that was treated with pancreatic enzyme supplementation, vitamin B12, and cimetidine developed oral bleeding. Following discontinuation of the cimetidine, increased preincubation of the enzymes with the food, and symptomatic therapy for the ulceration, the dog's condition improved.

Topics: Animals; Atrophy; Cimetidine; Dog Diseases; Dogs; Enzyme Inhibitors; Exocrine Pancreatic Insufficiency; Male; Oral Hemorrhage; Oral Ulcer; Pancreas; Vitamin B 12

Vitamin B12 deficiency can cause serious developmental regression, hypotonia and cerebral atrophy in infants. We report a 6-month-old infant, with insidious developmental regression and brain atrophy showed by CT scan, secondarily to vitamin B12 deficiency. His mother was a strict vegetarian and the patient was exclusively breastfed. The clinical symptoms and the brain CT were normalized after vitamin B12 administration.

Topics: Atrophy; Brain; Breast Feeding; Developmental Disabilities; Diet, Vegetarian; Humans; Infant; Male; Muscle Hypotonia; Radiography; Vitamin B 12; Vitamin B 12 Deficiency

We investigated the correlation of hippocampal volume with homocysteine, folate, vitamin B12 and B6 in alcoholic patients and healthy controls applying a Kohonen feature map (KFM) and conventional statistics. Representation of subjects on the KFM suggested an inverse correlation of hippocampal volume with blood levels of homocysteine and correlation with folate and vitamin B6. In conventional statistical analyses (t-test) reduced folate and increased homocysteine was found in alcoholics compared to healthy controls (p < 0.01). In female alcoholics vitamin B6 was reduced significantly (p = 0.03). Multiple linear regression analyses showed a significant correlation between average hippocampal volume and homocysteine (p < 0.001). KFM proved to be a sensitive tool for visualisation of statistical correlations in data sets even if no further statistical information is available.

Topics: Adult; Aged; Alcohol-Induced Disorders, Nervous System; Atrophy; Avitaminosis; Data Interpretation, Statistical; Ethanol; Female; Folic Acid; Hippocampus; Homocysteine; Humans; Linear Models; Male; Middle Aged; Neural Networks, Computer; Reference Values; Sex Factors; Vitamin B 12; Vitamin B 6

Topics: Aged; Alzheimer Disease; Atrophy; Female; Folic Acid; Humans; Male; Neocortex; Vitamin B 12

Elevated fasting plasma total homocysteine concentration (tHcy) and lower vitamin status are associated with atherosclerotic states. Silent brain ischemic lesions and brain atrophy, prevailing in the elderly, are affected by tHcy and vitamin status. The study was performed on 56 outpatients who had undergone brain computed tomography (CT) before the onset of the study. According to brain CT evaluation, three groups were set: minor brain ischemia, brain atrophy and control. Brain CT, tHcy, plasma pyridoxal phosphate (PLP), vitamin B(12), folic acid and cognitive and functional capacities were measured or evaluated in all of the subjects. Plasma vitamin score for three vitamins was calculated. In subjects with minor brain ischemic lesions (n = 21), tHcy was higher by 5.6 microM, whereas vitamin score and cognitive function were lower than in controls (n = 24). In subjects with brain atrophy (n = 11), plasma PLP and cognitive function were lower. Particular attention should be paid to tHcy monitoring, vitamin status assessment and brain impairment evaluation.

Topics: Aged; Aged, 80 and over; Atrophy; Brain; Brain Ischemia; Cognition Disorders; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Male; Vitamin B 12; Vitamin B 6; Vitamins

The early stages of tissue B12 or folate deficiency often cause diagnostic problems. In this report, the levels of serum cobalamin, folate, methylmalonic acid (MMA) and total homocysteine (tHcy), and their relationships with clinical findings and reported symptoms in a representative random population sample are presented.. Cohort study.. A general central Swedish population 70 years or older.. A 20% random sample of persons 70 years or older in a defined geographical area were invited to a survey. A total of 235 (85%) persons responded, of whom 161 had no interfering diseases or medication. Blood specimens for serum cobalamin, folate, MMA and tHcy analyses were drawn.. Presence of anaemic, gastrointestinal, neurological and psychiatric symptoms, obtained by questionnaire, and vibration sense measurement and findings at a physical and Mini Mental State Examination.. Among a large number of symptoms and clinical findings that traditionally have been linked to vitamin B12 or folate tissue deficiency, only changes in the tongue mucosa and mouth angle stomatitis turned out to be significantly associated with abnormal serum tHcy and serum folate levels. There were no relationships to serum cobalamin and serum MMA.. Changes in the oral mucosa were the only signs and symptoms found in this study, indicating that these may be the very early markers of metabolic defects. The traditional symptoms of vitamin deficiency may appear later in the course.

Topics: Aged; Atrophy; Cohort Studies; Female; Folic Acid; Health Surveys; Homocysteine; Humans; Male; Methylmalonic Acid; Mouth Diseases; Mouth Mucosa; Stomatitis; Tongue; Vitamin B 12; Vitamin B 12 Deficiency

The early onset type of cobalamin (Cbl) C/D deficiency is characterised by feeding difficulties, failure to thrive, hypotonia, seizures, microcephaly and developmental delay. It has an unfavourable outcome, often with early death and significant neurological impairment in survivors. While clinical and biochemical features of Cbl C/D deficiency are well known, only a few isolated case reports are available concerning neurophysiological and neuroimaging findings. We carried out clinical, biochemical, neurophysiological and neuroradiologic investigations in 14 cases with early-onset of the Cbl CID defect. Mental retardation was identified in most of the cases. A variable degree of supratentorial white matter atrophy was detected in 11 cases by MR imaging and tetraventricular hydrocephalus was present in the remaining 3 patients. Waking EEG showed a clear prevalence of epileptiform abnormalities, possibly related to the high incidence of seizures in these cases. Increased latency of evoked responses and/or prolongation of central conduction time were the most significant neurophysiological abnormalities. The selective white matter involvement, shown both by neuroradiologic and neurophysiological studies, seems to be the most consistent finding of Cbl C/D deficiency and may be related to a reduced supply of methyl groups, possibly caused by the dysfunction in the methyl-transfer pathway.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Atrophy; Brain; Brain Diseases, Metabolic, Inborn; Child; Child, Preschool; Cobamides; Cytosol; Electroencephalography; Evoked Potentials; Female; Follow-Up Studies; Homocystinuria; Humans; Infant; Intellectual Disability; Magnetic Resonance Imaging; Male; Methylmalonic Acid; Methylmalonyl-CoA Mutase; Seizures; Vitamin B 12; Vitamin B 12 Deficiency

In the present report, 101 ambulatory elderly patients complaining about cognitive disturbances were investigated using the Mini-Mental State Examination (MMSE). Laboratory investigations, brain imaging, and electroencephalography were performed. Twelve patients were diagnosed with subjective memory complaints (SMC), 32 with mild cognitive impairment (MCI), 43 with dementia of the Alzheimer type (DAT), and 14 with vascular dementia (VAD). Thirty-three percent of the SMC group, 31% of the MCI group, 45% of the DAT group, and 62% of the VAD group had increased serum homocysteine (s-HCY). Principal component analysis of 19 variables showed 3 significant principal components by cross-validation. The cognitive impairment in the patients (MMSE) was explained to 50%. According to the principal component analysis, the population followed two different routes to cognitive impairment: one correlated with disturbance of one-carbon metabolism (cerebrospinal fluid vitamin B12, plasma B12, plasma folate, and s-HCY) and the other correlated with more classic dementia, as marked by cerebrospinal fluid tau, vascular risk factors, atrophy on brain imaging, possession of the apolipoprotein E4 allele, and age. There was poor discrimination between DAT and VAD.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Apolipoproteins E; Atrophy; Brain; Cognition Disorders; Dementia, Vascular; Diagnosis, Differential; Female; Folic Acid; Homocysteine; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neuropsychological Tests; Reference Values; Severity of Illness Index; tau Proteins; Vitamin B 12

Chronic inflammation in the ileal pouch is the most significant late complication after ileal pouch-anal anastomosis (IPAA). It leads to changes in mucosal morphology, with consequent decreased vitamin B12, bile acid and cholesterol absorption documented. The aims of this study were to evaluate long term metabolic consequences at least 5 yr after IPAA and the influence of pouchitis on pouch histology and on bile acid, lipid, and vitamin B12, A, E, and D metabolism.. A total of 104 patients with a J-pouch who were operated on between 1985 and 1994, as well as 21 ulcerative colitis patients with a conventional ileostomy were enrolled for the study. Routine blood tests, vitamin status, vitamin B12 levels, and bile acid absorption were determined, as well as endoscopy with biopsies. The pouchitis disease activity index (PDAI) was calculated. On the basis of histology, IPAA patients were divided into three subgroups: 1) those with no villous atrophy, 2) those with partial villous atrophy, and 3) those with subtotal or total villous atrophy.. Incidence of pouchitis was 42.3%, and was strongly associated with villous atrophy. In IPAA patients with subtotal or total villous atrophy (32.7%), serum levels of albumin, calcium, total cholesterol, triglycerides, and vitamin E were significantly reduced (p < 0.05). The lowest bile acid and vitamin B12 absorption rates were seen in patients with inflammation in the proximal limb. Vitamin D deficiency was seen in 10.6%, and vitamin A and B12 deficiency in approximately 5% of IPAA patients.. Metabolic consequences after IPAA are associated with pouchitis, grade of villous atrophy, and extent of inflammation in the remaining ileum. Patients with active chronic inflammation need long term follow-up.

Topics: Adult; Aged; Atrophy; Bile Acids and Salts; Colitis, Ulcerative; Female; Humans; Lipids; Male; Middle Aged; Pouchitis; Time Factors; Vitamin B 12

No simple and reliable method of identifying patients with cobalamin malabsorption is available at present. The measurement of plasma holotranscobalamin, i.e. the metabolically active cobalamins bound to the transport protein transcobalamin, has been suggested as a means of fulfilling such criteria.. We describe a method that directly quantifies cobalamins attached to transcobalamin. The method is evaluated in patients referred for gastrointestinal examination because of suspected cobalamin malabsorption.. Of the 101 patients referred, all 48 with gastrointestinal conditions compatible with cobalamin malabsorption had plasma holotranscobalamin below 35 pmol L-1 (interval of 35-160pmol L-1). None of the patients with plasma holotranscobalamin above the lower reference limit had conditions compatible with cobalamin malabsorption.. The values obtained for plasma holotranscobalamin showed a better correlation with possible malabsorption than the values obtained for plasma cobalamins. The specificity of the test, however, needs to be elucidated further.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Atrophy; Female; Gastric Mucosa; Homocysteine; Humans; Intestinal Absorption; Male; Methylmalonic Acid; Middle Aged; Stomach; Transcobalamins; Vitamin B 12; Vitamin B 12 Deficiency

Developmental regression is the presenting symptom of most infants with cobalamin (Vitamin B12) deficiency. We present a report of three infants with cobalamin deficiency in which the infants also developed a movement disorder. In each case the mother was a vegetarian and the infant was exclusively breast-fed. In two of the infants, a striking movement disorder consisting of a combination of tremor and myoclonus particularly involving face, tongue, and pharynx appeared 48 h after the initiation of treatment with intramuscular cobalamin. This was associated with marked changes in plasma amino acid levels. Paradoxically, the onset of the movement disorder coincided with overall neurological improvement. The third infant had a persistent focal tremor, which appeared before the commencement of treatment. The movements slowly abated during a 3-6 week period. The presence of a movement disorder in cobalamin deficiency has received less attention than other features, but in a mild form is probably common. It may offer an early clue to the diagnosis before the onset of profound neurological deterioration. The cause of the severe movement disorder that can appear after treatment is not known.

Topics: Atrophy; Brain; Consanguinity; Developmental Disabilities; Diet, Vegetarian; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Injections, Intramuscular; Magnetic Resonance Imaging; Male; Neurologic Examination; Neuromuscular Diseases; Syndrome; Vitamin B 12; Vitamin B 12 Deficiency

Vitamin B12 deficiency is known to be associated with signs of demyelination, usually in the spinal cord. Lack of vitamin B12 in the maternal diet during pregnancy has been shown to cause severe retardation of myelination in the nervous system. We report the case of a 14(1)/2-month-old child of strictly vegetarian parents who presented with severe psychomotor retardation. This severely hypotonic child had anemia due to insufficient maternal intake of vitamin B12 with associated megaloblastic anemia. MRI of the brain revealed severe brain atrophy with signs of retarded myelination, the frontal and temporal lobes being most severely affected. It was concluded that this myelination retardation was due to insufficient intake of vitamin B12 and vitamin B12 therapy was instituted. The patient responded well with improvement of clinical and imaging abnormalities. We stress the importance of MRI in the diagnosis and follow-up of patients with suspected diseases of myelination.

Topics: Anemia, Megaloblastic; Atrophy; Brain; Demyelinating Diseases; Diet, Vegetarian; Female; Follow-Up Studies; Frontal Lobe; Humans; Infant; Magnetic Resonance Imaging; Muscle Hypotonia; Myelin Sheath; Pregnancy; Prenatal Exposure Delayed Effects; Psychomotor Performance; Temporal Lobe; Vitamin B 12; Vitamin B 12 Deficiency

The effect of vitamin B12 (B12)-deficiency on testicular tissue was investigated through morphological observations of the rats which had been fed on a B12-deficient soybean protein diet by pair-feeding for 100 days. Testicular B12 content was depressed distinctly by the deficiency. Testes weight and their relative weight (weight per 100 g body weight) as well, decreased significantly as compared with those of pair-feeding control rats. Although the decrease in the testicular B12 content due to B12-deficiency was compensated by the administration of cyanocobalamin (CN-B12), alleviation of the decrease in testes weight and relative testes weight was not observed under the condition of the short-term CN-B12 administration. Morphological observations of the testicular tissue in B12-deficient rats revealed atrophy of the seminiferous tubules and aplasia of sperms and spermatids, while testicular findings in both ad libitum-feeding control rats and pair-feeding control rats were normal. There was a tendency for the decrease in seminiferous tubules showing spermatogenesis to be alleviated by administration of CN-B12. The above results indicate that the morphological changes in the testicular tissue are ascribable to B12-deficiency.

Topics: Animals; Atrophy; Diet; Male; Organ Size; Rats; Rats, Wistar; Seminiferous Tubules; Soybean Proteins; Sperm Count; Spermatozoa; Testis; Vitamin B 12; Vitamin B 12 Deficiency

To assess the advantage of a protein-bound cobalamin absorption test (PBAT) over the Schilling test in patients with suspected cobalamin (vitamin B12) malabsorption.. Clinical study of consecutive patients referred from primary care units, medical and neurological clinics.. The catchment area of Sahlgrenska University Hospital, Göteborg.. Referred patients (n = 155) with suspected cobalamin deficiency and at least one serum cobalamin value < 200 pmol L-1.. All patients were investigated with upper gastrointestinal endoscopy with biopsies taken from the gastric body and duodenal mucosa. Serum methylmalonic acid (MMA) and homocysteine (Hcy) were determined in all 109 patients not on cobalamin substitution. A dual isotope cobalamin absorption test was then performed with the concomitant administration of crystalline (Schilling) and protein-bound cobalamin (PBAT).. Number of patients with gastric body atrophy diagnosed with each absorption test and the relation between these results and functional cobalamin deficiency defined as elevated MMA and Hcy, that normalized after cobalamin substitution treatment.. The majority of patients with abnormal absorption tests had already developed elevated MMA and/or Hcy. PBAT was more sensitive than the Schilling test in identifying patients with gastric body atrophy but the sensitivity was too low for clinical use. About 1/3 of the patients with gastric body atrophy and normal absorption tests had elevated MMA and/or Hcy, indicating cobalamin deficiency.. PBAT may be somewhat more sensitive than the Schilling test but neither test is sensitive enough for diagnosing cobalamin malabsorption at an early stage.

Topics: Adult; Atrophy; Duodenum; Female; Homocysteine; Humans; Intestinal Absorption; Male; Methylmalonic Acid; Reference Values; Reproducibility of Results; Schilling Test; Stomach; Sweden; Vitamin B 12; Vitamin B 12 Deficiency; Volunteers

Vitamin B12 malabsorption in the ileum has been postulated as the underlying cause of the Imerslund-Grasbeck syndrome comprising megaloblastic anemia, proteinuria, and multiple neurological abnormalities. A young Saudi child with spasticity, truncal ataxia, cerebral atrophy, megaloblastic anaemia and proteinuria is described. Replacement therapy with parenteral vitamin B12 resulted in the complete resolution of his neurological findings and brain atrophy.

Topics: Anemia, Megaloblastic; Atrophy; Brain Diseases; Cerebral Cortex; Child, Preschool; Humans; Male; Proteinuria; Syndrome; Tomography, X-Ray Computed; Vitamin B 12; Vitamin B 12 Deficiency

Gastrointestinal side-effects of prolonged therapy (greater than 2 yr) with the long-acting somatostatin analog octreotide were studied in 10 acromegalic patients. After 2 yr of therapy, 6 of 10 patients had newly developed gallstones, complicated by cholangitis and jaundice in 1. Serum vitamin B-12 concentrations declined in all 10 patients [from 380 +/- 32 to 172 +/- 21 pmol/L (mean +/- SE); P = 0.023] and became abnormally low in 4. Gastric biopsy specimens, obtained during gastroscopy (9 patients), showed moderate to severe active gastritis, with damage to the superficial and deeper layers of the mucosa in 9 of 9 and focal atrophy in 7 of 9 patients. Campylobacter pylori was found in the antral mucosa in 8 of 9 patients. Although information is lacking on similar studies in untreated acromegalic patients, we suggest that patients receiving chronic octreotide therapy be closely monitored for these and possible other side-effects related to gastrointestinal actions of octreotide.

Topics: Acromegaly; Adult; Aged; Atrophy; Cholelithiasis; Epithelium; Female; Gastric Mucosa; Gastritis; Gastrointestinal Diseases; Helicobacter pylori; Humans; Male; Middle Aged; Octreotide; Vitamin B 12

Small intestinal absorptive function was investigated in six patients with the acquired immunodeficiency syndrome (AIDS) who had diarrhoea and weight loss. Proximal function was assessed by [14C]Triolein test of fat absorption. Distal function was determined by a test of bile acid absorption in which the loss of radio-labelled synthetic bile acid, 75seleno-23-homocholic acid-taurine ([75Se]HCAT), from the enterohepatic circulation was quantified by abdominal gamma-scanning and by a vitamin B12-intrinsic factor absorption test. Concurrently indirect tests of small intestinal bacterial overgrowth ([14C]glycocholate and breath hydrogen) were carried out. In addition, jejunal histological examination and stool microscopy and culture for enteropathogens were performed. Fat absorption was reduced in all six patients, four of whom had jejunal villous atrophy. Bile acid and vitamin B12 absorption were normal in four subjects. Enteropathogens were not detected in any of the four subjects with normal terminal ileal absorptive function. In contrast, reduced bile acid and vitamin B12 absorption were detected in two of six subjects. Both patients had an enteropathogen (Cryptosporidium spp. and Isospora belli) present on stool and jejunal histological examination. Neither subject had evidence of small-intestinal bacterial overgrowth. AIDS patients therefore may have normal ileal absorptive function in the presence of jejunal disease. Infection with Cryptosporidium spp. or I. belli may however, be associated with severe ileal dysfunction.

Topics: Acquired Immunodeficiency Syndrome; Adult; Atrophy; Cryptosporidiosis; Dietary Fats; Female; Humans; Hyperplasia; Ileal Diseases; Intestinal Absorption; Jejunal Diseases; Malabsorption Syndromes; Male; Middle Aged; Vitamin B 12; Weight Loss

The contribution of VEP, CT and oligoclonal bands (OB) to the diagnosis of MS was studied in a group of 213 hospitalized patients. Whereas the diagnostic values of VEP and OB were both in the same range, the combination of both methods increased the proportion of cases with "definite MS" from 58 to 75%, whereas CT did not contribute significantly to diagnostic ascertainment. Vitamin B12 absorption was less than 10% in 27% of cases. A slight tendency towards increased serum IgG and IgM levels was found, and the rheumatoid factor was demonstrated in 6% of cases.

Topics: Adolescent; Adult; Aged; Atrophy; Brain; Electroencephalography; Evaluation Studies as Topic; Evoked Potentials, Visual; Female; Humans; Immunoglobulins; Male; Middle Aged; Multiple Sclerosis; Thyroid Hormones; Tomography, X-Ray Computed; Vitamin B 12

Subcellular biochemical features of a naturally occurring enteropathy in the dog resembling chronic tropical sprue in human beings were examined. Affected dogs had reduced xylose absorption and low concentrations of serum folate, RBC folate, and serum vitamin B12. Histologic examination of peroral jejunal biopsy specimens revealed villous atrophy and a variable infiltration of lymphocytes and plasma cells in the lamina propria. Biochemical assessment of the principal subcellular organelles was achieved by the assay of specific marker enzymes in homogenized jejunal biopsy specimens and in the gradient fractions after isopyknic centrifugation on continuous sucrose-density gradients. Activities of brush-border marker enzymes were reduced. However, there was no change in the equilibrium density of this organelle, indicating that these quantitative brush-border changes were not accompanied by an alteration in the composition of the microvillous membrane. Activities of lysosomal enzymes were increased, and there was evidence of enhanced lysosomal fragility and a proliferation of the endoplasmic reticulum. These findings were consistent with an impairment of the functional capacity of the small intestinal mucosa and implicated lysosomes and the endoplasmic reticulum in the disease process.

Topics: Animals; Atrophy; Biopsy; Dog Diseases; Dogs; Humans; Intestinal Absorption; Intestinal Diseases; Jejunum; Microvilli; Sprue, Tropical; Vitamin B 12

Gastric morphology, function, and immunology was studied in 68 patients with pernicious anemia (PA), 183 of their first-degree relatives, and 354 control subjects. The PA relatives and controls were comparable in age and sex distribution. In both groups, mean gastric acid output decreased and mean fasting serum gastrin levels and the prevalence of atrophic gastritis increased with age. The total prevalence of chronic gastritis was similar in the two groups, but severe atrophic gastritis of the body of the stomach (AGB), achlorhydria, parietal cell antibodies, and a raised fasting serum gastrin level were significantly more common in PA relatives than in controls. Of the PA relatives 23 had severe AGB which was indistinguishable from the gastric mucosal lesion found in PA probands and was, as a rule, accompanied by several other characteristics of type A gastritis. These included a normal antrum (78%), slight or absent inflammatory cell infiltration in the gastric mucosa (70%), achlorhydria (91%), high fasting serum gastrin level (83%), parietal cell antibodies (65%), and intrinsic factor antibodies (22%). The mean age and the proportion of subjects with slight and moderate AGB of all AGB subjects was significantly lower in PA relatives than in controls. This suggests an early onset and a rapid progression from mild to severe AGB in PA relatives. Thus, the PA relatives appear to consist of two populations, one with a high and one with little or no proneness to severe AGB. This bimodal distribution suggests the participation of a single major factor, probably genetic, in the pathogenesis of severe AGB in PA relatives.

Topics: Adolescent; Adult; Age Factors; Anemia, Pernicious; Atrophy; Autoantibodies; Consanguinity; Female; Gastric Juice; Gastric Mucosa; Gastrins; Gastritis; Humans; Intestines; Intrinsic Factor; Male; Metaplasia; Middle Aged; Pyloric Antrum; Vitamin B 12

Twenty-one patients (4 females and 17 males) were re-examined 20 years after partial gastrectomy for benign peptic ulcer. Different stages of morphological change in the gastric stump mucosa were compared with haematological parameters as well as with gastric acid and IF secretions. Biopsy specimens were taken by the direct vision technique. Haematological values including also serum vitamin B12, folate and Schilling test were determined. Gastric acid and IF secretions were lower in all patients with "selective parietal cell atrophy" in the gastric mucosa compared with those of other patients. Serum B12 and Schilling test values showed the same tendency. The present study indicates that it is possible to determine the gastric function dependent on parietal cells according to morphological criteria.

Topics: Atrophy; Female; Gastrectomy; Gastric Juice; Gastric Mucosa; Gastritis; Hemoglobins; Humans; Intrinsic Factor; Male; Postgastrectomy Syndromes; Schilling Test; Vitamin B 12

Five of 33 patients with dermatitis herpetiformis (DH) were found to have gastric parietal cell antibody in their sera, whereas it was not found in 30 healthy controls of comparable age distribution. Fifteen of the patients with DH underwent further studies to investigate the histological and functional state of their gastric mucosa. Atrophic gastritis was found in all five patients whose sera contained gastric parietal cell antibody and in three of 11 patients with no antibody in their sera. In addition, there was marked impairment of acid secretion in the DH group as a whole, but, apart from one patient with overt pernicious anaemia (PA), there was no evidence of malabsorption of B12.

Topics: Adolescent; Adult; Aged; Anemia, Pernicious; Atrophy; Autoantibodies; Dermatitis Herpetiformis; Female; Fluorescent Antibody Technique; Gastric Juice; Gastric Mucosa; Gastritis; Humans; Male; Middle Aged; Pentagastrin; Schilling Test; Vitamin B 12

Topics: Adult; Atrophy; Dermatitis Herpetiformis; Dietary Carbohydrates; Female; Glutens; Humans; Intestinal Absorption; Intestinal Mucosa; Intestine, Small; Malabsorption Syndromes; Male; Middle Aged; Vitamin B 12; Xylose

Topics: Achlorhydria; Adult; Aged; Anemia, Pernicious; Atrophy; Autoantibodies; Autoimmune Diseases; Female; Follow-Up Studies; Gastritis; Humans; Intrinsic Factor; Malabsorption Syndromes; Male; Middle Aged; Schilling Test; Time Factors; Vitamin B 12

Topics: Adolescent; Anemia, Pernicious; Antibodies; Atrophy; Biopsy; Erythrocyte Count; Female; Gastric Mucosa; Hemoglobins; Humans; Intrinsic Factor; Reticulocytes; Vitamin B 12

Topics: Anemia, Macrocytic; Atrophy; Autopsy; Blood Vessels; Brain; Brain Chemistry; Cerebrosides; Child; Cholesterol; Chromatography, Thin Layer; Demyelinating Diseases; Esters; Fatty Acids; Fatty Acids, Unsaturated; Female; Galactose; Gliosis; Globus Pallidus; Homocystinuria; Humans; Malonates; Metabolism, Inborn Errors; Phosphatidylcholines; Phospholipids; Sphingomyelins; Sulfoglycosphingolipids; Vitamin B 12

An investigation of 102 men comprising alcoholics, patients with non-ulcer dyspepsia, and healthy controls is reported. It demonstrates that alcohol is a cause of chronic gastritis and the severity of the mucosal lesion is directly related to the duration of excess drinking. Contrary to popular belief, chronic gastritis does not give rise to symptoms. The effect of alcohol on the gastric mucosa is a direct one and is not mediated by malnutrition, hepatic damage, intestinal malabsorption, anaemia, ascorbic acid deficiency, or any disturbance in immune tolerance. The natural history of chronic gastritis is described, involving an initial hypertrophy and hyperfunction of the gastric mucosa, followed by atrophy and hypofunction. Cigarette smoking is confirmed as another cause of chronic gastritis. The non-ulcer dyspepsia syndrome is unrelated to chronic gastritis.

Topics: Adolescent; Adult; Alcoholism; Atrophy; Chronic Disease; Dyspepsia; Gastric Juice; Gastric Mucosa; Gastritis; Humans; Hypertrophy; Male; Middle Aged; Nutrition Disorders; Radiography; Smoking; Time Factors; Vitamin B 12

Topics: Atrophy; Biopsy; Carcinoma; Cobalt Isotopes; Gastric Acidity Determination; Gastric Mucosa; Gastroscopy; Humans; Staining and Labeling; Stomach Diseases; Stomach Neoplasms; Vitamin B 12

Topics: Adult; Atrophy; Blood-Brain Barrier; Bone Diseases; Deafness; Electrophoresis, Disc; Female; Foot Diseases; Humans; Injections, Intramuscular; Spinal Dysraphism; Ulcer; Vestibulocochlear Nerve; Vitamin B 12

Gastric carcinoma was detected nine, 10, 18, and 21 years after the biopsy diagnosis of atrophic gastritis in four patients of a group of 40. The gastritis was presumed to be of the simple type. Tests of vitamin B(12) absorption in three patients gave normal results, no gastric autoantibodies were detected in the two patients tested, in all patients histological examination of the gastrectomy specimens revealed a multifocal gastritis differing from the diffuse gastritis of pernicious anaemia and in three patients the gastritis affected the antrum, which is unusual in pernicious anaemia. The 10% incidence of gastric carcinoma in 40 patients with simple atrophic gastritis followed for a mean period of 15 years is equivalent to that previously described in pernicious anaemia. However, in view of the relative incidence of atrophic gastritis with and without pernicious anaemia in the general adult population, it emerges that atrophic gastritis without pernicious anaemia is numerically the more important precursor of gastric carcinoma.

Topics: Adult; Anemia, Pernicious; Atrophy; Autoantibodies; Biopsy; Female; Follow-Up Studies; Gastrectomy; Gastritis; Humans; Intestinal Absorption; Male; Middle Aged; Precancerous Conditions; Pylorus; Stomach Neoplasms; Vitamin B 12

Topics: Adolescent; Adult; Anemia, Macrocytic; Atrophy; Biopsy; Bone Marrow Cells; Child; Cobalt Isotopes; Diarrhea; Edema; Female; Folic Acid; Folic Acid Deficiency; Humans; Intestinal Absorption; Intestinal Mucosa; Jejunum; Liver Diseases; Malabsorption Syndromes; Male; Middle Aged; Protein Deficiency; Serum Albumin; Vitamin B 12; Vitamin B 12 Deficiency

Topics: Atrophy; Brain Diseases; Humans; Multiple Sclerosis; Spinal Cord Diseases; Vitamin B 12

Topics: Achlorhydria; Adolescent; Anemia, Pernicious; Atrophy; Biopsy; Erythrocyte Count; Gastric Mucosa; Gastritis; Hemoglobins; Humans; Male; Oral Manifestations; Radiography; Vitamin B 12

Topics: Achlorhydria; Adult; Agammaglobulinemia; Anemia, Pernicious; Antibodies; Arthritis, Rheumatoid; Atrophy; Autoimmune Diseases; Colitis, Ulcerative; Diarrhea; Female; Fluorescent Antibody Technique; gamma-Globulins; Gastric Mucosa; Gastritis; Giardiasis; Humans; Hypersensitivity; Hypersensitivity, Delayed; Infections; Intrinsic Factor; Male; Middle Aged; Vitamin B 12

Topics: Adult; Aged; Anemia, Pernicious; Antigen-Antibody Reactions; Atrophy; Biopsy; Complement System Proteins; Female; Fluorescent Antibody Technique; Gastric Mucosa; Gastritis; Humans; Intrinsic Factor; Male; Middle Aged; Vitamin B 12

Topics: Adult; Anemia, Pernicious; Asian People; Atrophy; Autoantibodies; Female; Gastritis; Hong Kong; Humans; Hyperthyroidism; Intestinal Absorption; Intrinsic Factor; Male; Middle Aged; Stomach; Vitamin B 12

Topics: Achlorhydria; Aged; Anemia, Pernicious; Animals; Antigen-Antibody Reactions; Atrophy; Biopsy; Diabetes Mellitus; Female; Fluorescent Antibody Technique; Gastric Juice; Gastric Mucosa; Gastritis; Humans; Immune Sera; Intrinsic Factor; Male; Middle Aged; Prednisolone; Rats; Regeneration; Reticulocytes; Schilling Test; Stomach; Stomach Diseases; Thyroiditis, Autoimmune; Vitamin B 12

Topics: Adult; Aged; Anemia, Pernicious; Antibodies, Antinuclear; Antigen-Antibody Reactions; Atrophy; Autoantibodies; Female; Gastric Juice; Gastric Mucosa; Gastritis; Humans; Intestinal Absorption; Intrinsic Factor; Male; Middle Aged; Stomach Diseases; Vitamin B 12

Topics: Atrophy; Cobalt Isotopes; Dexamethasone; Gastric Mucosa; Gastritis; Humans; Intestinal Mucosa; Male; Metaplasia; Middle Aged; Vitamin B 12

Topics: Aged; Antibodies; Atrophy; Biopsy; Fluorescent Antibody Technique; Gastric Juice; Gastric Mucosa; Gastritis; Histamine; Humans; Intrinsic Factor; Iron; Male; Middle Aged; Schilling Test; Vitamin B 12; Vitamin B 12 Deficiency

A method employing non-radioactive vitamin B(12) and microbiological assay is described for estimating intrinsic factor in gastric juice and for detecting antibody to intrinsic factor in serum. Satisfactory agreement was obtained between the results by this method and by a modification of the method of Ardeman and Chanarin (1963). During the first hour after gastric stimulation 11 patients with pernicious anaemia secreted between 0 and 240 units of intrinsic factor compared with between 1,600 and 39,000 units in 21 patients with other conditions. The results in three out of four patients with gastric atrophy were higher than those in pernicious anaemia but lower than in other conditions.

Topics: Anemia, Pernicious; Antibodies; Atrophy; Biological Assay; Cobalt Isotopes; Gastric Juice; Humans; Intrinsic Factor; Lactobacillus; Methods; Stomach Diseases; Vitamin B 12

Topics: Adrenal Glands; Anemia, Pernicious; Antibodies, Anti-Idiotypic; Antibody Formation; Atrophy; Gastric Mucosa; Humans; Intrinsic Factor; Thyroid Gland; Vitamin B 12

Topics: Atrophy; Gastric Acidity Determination; Gastritis; Histamine; Humans; Intrinsic Factor; Urine; Vitamin B 12

Topics: Atrophy; Biopsy; Carbohydrate Metabolism; Colitis; Colitis, Ulcerative; Electrons; Feces; Fluids and Secretions; Gastritis; Intestinal Absorption; Intestine, Small; Lipid Metabolism; Microscopy; Microscopy, Electron; Pathology; Stomach; Vitamin B 12; Xylose

Topics: Anemia; Anemia, Pernicious; Atrophy; Cobalt Isotopes; Drug Therapy; Gastric Acidity Determination; Gastric Mucosa; Geriatrics; Hematinics; Humans; Intrinsic Factor; Pathology; Prednisolone; Regeneration; Vitamin B 12

Topics: Achlorhydria; Anemia; Anemia, Hypochromic; Anemia, Pernicious; Atrophy; Blood Chemical Analysis; Cobalt Isotopes; Deglutition Disorders; Gastric Acidity Determination; Hemoglobinometry; Histamine; Humans; Iron; Middle Aged; Plummer-Vinson Syndrome; Schilling Test; Stomach; Urine; Vitamin B 12

Topics: Anemia; Anemia, Pernicious; Atrophy; Bodily Secretions; Cathepsins; Cobalt Isotopes; Gastric Juice; Gastric Mucosa; Gastritis; Gastritis, Atrophic; Histamine Release; Humans; Pepsin A; Urine; Vitamin B 12

Topics: Achlorhydria; Anemia; Anemia, Pernicious; Atrophy; Chemical Phenomena; Chemistry; Erythropoiesis; Gastric Juice; Gastric Mucosa; Gastritis; Gastrointestinal Hormones; Humans; Intrinsic Factor; Metabolism; Peptic Ulcer; Pharmacology; Physiology; Vitamin B 12

Topics: Atrophy; Duodenal Ulcer; Gastritis; Gastritis, Atrophic; Humans; Intrinsic Factor; Polyps; Stomach Diseases; Stomach Neoplasms; Stomach Ulcer; Vitamin B 12

Topics: Atrophy; Biopsy; Gastric Juice; Gastric Mucosa; Gastritis; Gastritis, Atrophic; Humans; Intestinal Absorption; Intestines; Stomach Diseases; Suction; Vitamin B 12

Topics: Adrenal Cortex; Adrenal Glands; Atrophy; Corrinoids; Hematinics; Thiouracil; Vitamin B 12

Topics: Anemia, Pernicious; Atrophy; Biopsy; Hematinics; Humans; Research; Vitamin B 12; Vitamin B Complex