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Vitamin B12 deficiency and folate deficiency are common causes of macrocytic anaemia and both are important for many cellular processes. These deficiencies could be due to inadequate dietary intake, impaired absorption or drug ingestion. We present a case of a 47-year-old male with a history of diffuse large B-cell lymphoma (DLBCL) who was admitted for fatigue, persistent frontal headache and left upper-quadrant abdominal pain. Further investigation showed that he had pancytopenia with microangiopathic haemolytic anaemia (MAHA) and intracranial bleeding (ICB). Serum vitamin B12 and folate were later found to be low and a diagnosis of combined vitamin B12 and folate deficiency mimicking thrombotic thrombocytopenic purpura (TTP) was made. The patient responded well to vitamin B12 and folate replacement.

Background and Objective: Verrucous carcinoma is a rare clinicopathologic entity caused by multifactorial influences. We report here a 64-year-old male patient presenting with a large exophytic mass in the right leg. Results and Conclusion: The patient had a 19-year duration of psoriasis and received various treatments. In his last year of life, he had been taking an illegally produced folk drug with the hope of controlling his psoriasis. However, 6 months after the drug ingestion, many papules appeared on his right leg, which eventually developed into a large tumor in the next few months. The patient died of acute pulmonary embolism only a week after hospitalization, when his tumor was pathologically confirmed as verrucous carcinoma. Later, the folk drug was analyzed and found to contain arsenic. The causative relevance of the tumor with his daily arsenic intake is discussed. Contexte et objectif: Le carcinome verruqueux est une entité clinicopathologique rare, causée par divers facteurs. Nous exposons ici le cas d'un homme de 64 ans, qui a consulté pour une grosse masse exophytique sur la jambe droite. Résultats et conclusions: Le patient souffrait de psoriasis depuis 19 ans et a été soumis à divers traitements. Au cours de sa dernière année de vie, il a pris un remède empirique traditionnel, illégal, dans l'espoir de soulager le psoriasis. Cependant, 6 mois après la consommation du remède, de nombreuses papules sont apparues sur la jambe droite, et ont fini par former une grosse tumeur au cours des mois suivants. Le patient est mort d'une embolie pulmonaire aiguë, une semaine seulement après son hospitalisation, lorsque l'examen histopathologique de la tumeur a révélé qu'il s'agissait d'un carcinome verruqueux. Le remède a été analysé plus tard, et il s'est avéré que celui-ci contenait de l'arsenic. Le lien de cause à effet entre la tumeur et la consommation quotidienne d'arsenic fera l'objet de discussion.

The most important cause of hypoglycaemia in the presence of high insulin and C-peptide concentrations is insulinoma. However, a similar picture arises from use of sulphonylureas, which is sometimes covert. All specimens received in two years by a supraregional assay service laboratory from adults with low glucose and inappropriately high insulin and C-peptide concentrations were tested for sulphonylureas by a radioimmunoassay that employed antibodies to glibenclamide. In sulphonylurea-positive cases a questionnaire was sent to the consultant responsible for the patient, to elicit further information. Samples from 93 adult patients met the criteria, and 34 (37%) of these gave a positive result on screening for sulphonylureas. The consultants provided further information on 31 of the 34, and in 20 the presence of a sulphonylurea was unexpected. In 10 the features were such as to raise the possibility of factitious drug ingestion. A simple screening technique applied to specimens from patients with hyperinsulinaemic hypoglycaemia indicated that, in a substantial proportion of cases, the patient was taking a sulphonylurea.

An analysis is made of adolescent hallucinogenic plant ingestion during initiation rituals among Australian Aboriginal males, Tshogana Tsonga females and among Chumash youth of Southern California. This use pattern contrasts with abusive patterns of drug abuse found among American adolescents. Findings indicate the existence of managed altered states of consciousness in the tribal societies studied, where plant hallucinogens are given by elders to youth as part of an intensive, short-term socialization for religious and pedagogical purposes. The use of hypersuggestibility as a cultural technique to “normalize” youth in the tribal societies under study is analyzed in contrast to the role of pathology of drug ingestion patterns among American adolescents.

The underlying basis for the process-reactive classification is unclear, although some authors offer differences in psychological differentiation as an explanation. This study examined the relationship between the degree of differentiation of the body concept and the process-reactive continuum, which was measured by the Prognostic Rating Scale and the subsequent total number of nights of hospitalization over a 3-yr. period for 51 Ss. There was no significant relationship—linear or curvilinear—between these variables in this sample of acute schizophrenics in whom drug ingestion, chronicity, and length of current hospitalization were controlled.

The timing of drug ingestion over 24 hours was assessed in 58 outpatients taking drugs three times daily. The mean time between 1st and 2nd dose was 5.7 hours, 2nd and 3rd 6.1 hours and between 3rd and 1st of the next day 12.2 hours. Based on a simulation of hydralazine pharmacokinetics, such irregular administration would increase peak levels by 10% and decrease trough levels by 64% compared with regular 8-hourly doses.