[Which symptoms appear first: iron deficiency or geophagia?].
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Biomedical subjects
Publications and source records attributed to C Hadnagy.
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The case of a trichophagic child is presented. Oral and intramuscular iron therapy brought only temporary effect at the age of 3. Seven years later the 10-year-old highly intelligent girl ate again hair. She was not anaemic and her serum iron level was not low. Intravenous iron injections applied again ceased immediately the psychic aberration that did not return even after 4 years. The authors are of the opinion that in cases of such psychic anomalies the iron content of the iron-rich cerebral ganglia is lower than normal and the disturbance can be ceased by the administration of iron.
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Besides of four pica cases (eating of dirt, paper, cotton, oakum, sand, lime, chalk) the authors report on a girl with trichophagia. The treatment of choice in pica consists in a sufficient supply of iron. The authors suggest that the intravenously administered iron acts on some centers of the central nervous system.
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In 352 patients affected with chronic lymphatic leukemia (CLL) the authors simultaneously detected a solid second tumour 22 times (= 6.22%) (6 cancers of the prostrate, 5 cancers of the skin, 4 cancers of the uterus, 2 cancers of the stomach, 2 cancers of the lung, one case of rectal and mamma cancer each and one case of eye sarcoma). In one third of the cases the two malignomas were simultaneously detected, thus it was excluded that the second tumour was induced by the antimitotic treatment of the primary disease. In seven cases the solid tumour was identified after diagnosing CLL, without any cytostatic therapy having been made here before. In addition, a report is given on a patient showing symptoms of gastric cancer not radically removed and a lymphocytic reaction. Initially, the case was explained as gastric adenocancer with simultaneous CLL because even 5 years after surgical treatment there were 16-20 X 10(6)/l of leukocytes with 64% of lymphocytes in the peripheral blood and 85% of lympho-reticular cells in the bone marrow. Two years later, however, the blood picture was normal and remained to be unchanged further on. Thus, it seems that the healing of the gastric cancer has caused the lymphocytic reaction to have ceased. In addition, it should be noted that in 1974 the patient suffered from an epithelium after a scratch-mark on the nose tip, which was irradiated, however, without eliciting any lymphocytic reaction. The patient is still alive (June 1985).
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Two unrelated cases of congenital dyserythropoietic anaemia (CDA) are described. They show striking similarities which could not be attributed to one of the well-known types of CDA or any other congenital disease of the erythroid system. Both patients were followed for many years before and after splenectomy. There was a long-lasting, prominent post-splenectomy erythroblastosis, suggesting impairment of red cell denucleation. The type of heredity is unknown, and the enzymatic or molecular basis of the changes observed is not understood.
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There are reported two cases of infectious mononucleosis in elderly. In the first case (80 years; probably the oldest in the geriatric literature) the infection provoked a very serious illness and the patient deceased three months after dimission, because of diminished resistance. In the second case the mononucleosis induced an autoimmune haemolytic anemia. The patient's daughter and granddaughter must be treated for complications of an infectious mononucleosis too.
The serum folate level of 100 aged persons (after 70) was decreased (less than 4 ng/ml) in 41% of the cases (manifest deficiency of folic acid). In the group of aged persons having normal folate values, in 41% of the cases the clearance method proved a latent folic acid deficiency, being the 15 minute value after 15 gamma/kg folic acid i.v., less than 25 ng/ml.
The authors examined 143 members of a family, where they found 37 (= 25.87%) of Osler patients. It was only in 30% of these patients that the symptoms occurred before the tenth year of age. As in one patient the symptoms did not appear until the age of 58 years, the possibility cannot be excluded that symptoms of the disease will become manifest even in other, sill younger members of the family in the course of time. Epistaxis was observed in 93% of the cases, nephrorrhagia in no case, hepatopathy and gastrorhagy were found only once in each case. The X-ray examination revealed arteriovenous pulmonary aneurysm in 5 cases. As a rule, oestrogen treatment led to good results. A case of death occurred during an influenza epidemic in a severe anaemic patient. Clinical main symptoms of Osler's disease were epistaxis and arteriovenous fistulae which could be roentgenologically identified in the lung. Teleangiectasia could be detected during the autopsy besides vessel anomalies on the surface even in the bronchi, oesophagus, trachea, stomach, kidneys, small intestine and particularly in the large intestines. Conditions of iron deficiency may very often occur in osler Patients; they require a substituting treatment.