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We conclude that a hiatal hernia, with or without visible Cameron lesions, is a real and maybe underestimated cause of IDA. Finding a large hiatal hernia on upper endoscopy, together with a negative colonoscopy, completes the diagnostic work-up of IDA in most of these elderly patients. Currently, no guidelines concerning the optimal therapeutic management of this problem are available. Therapy may depend upon the need of transfusion, the efficiency of medical treatment, the risks of surgery and the preference and general condition of the patient.

The gravity dependence of phases III (IIIa and IIIb), IV, and V of simultaneously performed He-bolus and N2-resident gas single-breath washout curves was studied in different body positions by the technique of 180 degrees body inversion between inspiration and expiration. Phase IIIa was mainly determined by nongravitational factors. Phase IIIb was influenced by gravitational, as well as nongravitational, factors. The former were more important with the bolus method in both lateral decubitus positions and the latter with the N2 method in the prone and supine positions. Phases IV and V were mainly gravity dependent. The difference in gravity dependence between the He and N2 methods appeared to be correlated with the vertical interregional concentration gradients of both gases; indeed the vertical gradient was larger for the 133Xe bolus inhaled at residual volume (which is comparable to the He-bolus distribution) than for the 133Xe residual volume-to-total lung capacity ratio (which is comparable to the N2-resident gas distribution). The greater gravity dependence in the lateral decubitus positions than in the supine or prone postures was related to the larger vertical interregional concentration difference as well as to the more pronounced sequential ventilation in the former positions. Finally the negligible effect of gravity on phase IIIa, its moderate effect on phase IIIb, and its predominant effect on phases IV and V were in agreement with the increased sequential filling and emptying due to gravity near residual volume.

A 74-year-old male patient presented with progressive anorexia, cholestatic liver function tests, and a diffuse enlarged pancreas suggestive of a pancreatic carcinoma. There was a marked elevation of total immunoglobulin G4 (IgG4) in serum. Further investigation led to the diagnosis of IgG4-related sclerosing disease with involvement of the pancreas, retroperitoneal fibrosis, and bilateral focal nephritis. To our knowledge, this is the first report on these 3 clinical entities occurring in the same patient.A short review of the literature concerning autoimmune pancreatitis and retroperitoneal fibrosis is made, with special interest to the concept of IgG4-related pathology. This systemic disease can have several clinical manifestations: IgG4-positivity not only can be found in the pancreas, but also at the level of extrahepatic biliary ducts, gallbladder, salivary glands, retroperitoneal tissue, kidneys, ureters, and lymph nodes. Although further investigation is required to determine its exact pathophysiologic role, IgG4 seems to be an important key player.