Vitamin B12 deficiency was found in 10 of 41 patients who underwent radiotherapy before cystectomy with Bricker urinary diversion for carcinoma of the bladder. Of 13 patients given full irradiation because of inoperable bladder cancer 5 had malabsorption of vitamin B12. Serum folic acid was normal in these patients, indicating predominantly ileal irradiation sequelae. Routine evaluation of serum vitamin B12 after radiotherapy is recommended so that appropriate medication can be given, if possible before neurological symptoms appear.
A patient with hypersplenism, massive splenomegaly, splenic vein thrombosis, and portal hypertension was man aged with preoperative embolization of the splenic artery.Blood flow measurements before, during, and after the embolization were determined by the video dilution tech nique [1][2][3][4]. After embolization, there was a marked fall in splenic blood flow, whereas hepatic and superior mesen teric artery flows increased significantly.Measurement of sequential flow degradation during em bolization allows controlled reduction of flow during embo lization, thereby potentially increasing the safety of emboli zation procedures [5]. We believe that the method has much promise for monitoring of partial splenic embolization [6, 7] in the treatment of hypersplenism. This patient's splanchnic hemodynamics were distinctly abnormal and interesting. The two-to threefold increase in flow through the splenic artery is known to occur sometimes in portal hypertension. The corresponding markedly dimin ished hepatic artery flow documents a "steal" phenomenon occurring in the celiac axis, which was reversed by the embolization procedure. The diminished relative superior
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