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1. Radio-iron absorption measurements were performed in healthy volunteer subjects to assess the availability of fortification Fe added to various bread products. 2. When ferrous sulphate was used as a fortifier, Fe absorption from a traditional Egyptian flat bread (Baladi) averaged only 16% of that observed with European bread. This difference was attributed to the high extraction flour used to prepare Baladi bread. 3. The inhibiting effect of Baladi bread was largely eliminated by adding EDTA to the flour before baking.

Previous human studies have shown that drinking tea during meals significantly inhibits the absorption of both food iron and medicinal iron. This study provides evidence from experiments with rats that the tannins in the tea are responsible for the inhibition, probably by forming non-absorbable complexes with the iron within the intestinal lumen. The molar ratio of tannin: iron is dependent on the pH, being 1:1 at pH 2,0 2:1 at pH 5,5 and 3:1 at pH 8,0. Since tannins are present in many vegetable foods the formation of such complexes may be a factor in the poor availability for absorption of much food iron.

Hemoglobin-repletion tests in rats, organoleptic studies, and iron-absorption studies in humans were used to search for Fe sources with high bioavailability that could be added to infant cereals as alternatives to the Fe compounds currently used for fortification. From rat and organoleptic studies on 11 alternative Fe sources, ferrous fumarate, ferrous succinate, and ferric saccharate were selected as the most suitable for infant-cereal fortification and, by use of radioactive labels, absorption of those compounds from fortified cereal was measured in adult human volunteers. There was no difference in absorption between ferrous fumarate and ferrous sulfate whereas the values for ferrous succinate, ferrous saccharate (10% Fe), and ferric pyrophosphate were 92%, 74%, and 39% of the ferrous sulfate values, respectively. We conclude that ferrous fumarate and ferrous succinate are highly available Fe sources in man that can be used to fortify infant cereals without causing fat oxidation or discoloration.

The absorption of radioactive iron from a solution of ferrous ascorbate, and from a standard meal containing intrinsically labelled haemoglobin and wheat, was measured in 12 Indian housewives, 18 white hospital patients and 12 subjects with idiopathic haemochromatosis. Eight of the latter had been fully treated by multiple venesections, so that their serum ferritin concentrations were below 25 mug/1. Since the serum ferritin concentrations of the housewives and the hospital patients were comparable, their body iron stores were considered to be depleted to a similar degree. There were no significant differences between the absorptions of ferrous ascorbate or of the haem iron in the standard meal by each group, but the housewives and the hospital patients absorbed significantly less of the non-haem food iron. The mean non-haem food iron absorptions were 36.4%, 5.8% and 18.9% for the treated haemochromatotic subjects, the Indian housewives and the white hospital patients respectively. The discrepancies between the absorptions of the different forms of food iron were highlighted by calculating the ratios between them. The mean non-haem: haem food iron absorption ratio for the group of treated haemochromatotic subjects was 0.98, and for the Indian housewives only 0.18. The white hospital patients did not form a homogenous population: the ratios of the five males and three of the females were greater than 1.0, whereas those of the remaining 10 females were less than 0.5. The results of this study suggest that mal-absorption of non-haem iron from a meal containing bread, presumably due to a defect at the luminal level, may be an important factor in the pathogenesis of iron deficiency in some subjects. The abnormality appears to be particularly prevalent among Indian women living in Durban.

Iron deficiency anemia is prevalent throughout the world because of the inefficient absorption of nonheme iron which forms the bulk of the iron in the diet. Absorption of this type of iron is impaired by substances in food which reduce its availability. Ascorbic acid reverses the effect of dietary inhibitors and is one of the most powerful known promoters of nonheme iron absorption. It facilitates iron absorption by forming a chelate with the ferric iron in food at the acid pH of the stomach; the chelated iron remains soluble at the alkaline pH of the duodenum. However, the consumption of ascorbic acid with a vegetarian meal containing primarily nonheme iron could improve the absorption of iron for an individual whose diet contains little or no heme iron. Unfortunately, relatively high cost and instability of ascorbic acid during food storage have proven to be major obstacles to its use in combating nutritional iron deficiency in developing countries.

Osteomyelitis of the jaws caused by a Bacteroides species is uncommon. A case of osteomyelitis of the mandible caused by penicillin-resistant Bacteroides ruminicola is reported. The diagnosis was confirmed by isolation of the organism and bone scan (99mTc medronate disodium) of the mandible. Clindamycin and hyperbaric oxygen therapy resolved the infection.

The accuracy and precision of measurements of iron status made on the capillary blood from a single 75 X 1-mm microhematocrit tube were evaluated in 301 normal volunteers. After recording the hematocrit value, a hematofluorometer was used to assay erythrocyte protoporphyrin directly on the packed red cell fraction. Values in the low normal range were 50-100% higher than assays by an extraction technique in simultaneously collected venous blood. However, measurements in the iron deficient range were only 12% greater. Plasma ferritin concentration was determined by using an enzyme-linked immunoassay on 10-microliters plasma retrieved after measuring the hematocrit. Capillary values were approximately 7% higher than venous concentrations, the proportional difference being consistent throughout the measured range. When the individual measurements were combined to calculate the iron storage status of each individual, the frequency distribution of iron stores in 141 female volunteers between 18 and 36 years of age was approximately Gaussian and paralleled that calculated for women aged 18-44 years in NHANES II. These studies demonstrate that iron status can be determined accurately from the measurement of hematocrit, erythrocyte protoporphyrin, and ferritin on a single microhematocrit tube of capillary blood.

B- and T-cell surface markers were determined in 26 adult patients with lymphoproliferative malignancies who had bone marrow and blood involvement. The patients in whom more than 60% of the abnormal cells were immunoglobulin-bearing cells were considered to have B-cell lymphoproliferative malignancy. The diagnosis of a T-cell disorder was made in those patients in whom more than 70% of the cells formed E rosettes (T cells). Those patients in whom 30% and more of the abnormal cells did not show B- and T-cell surface markers were regarded as suffering from "null" cell disorder. The B-cell type of lymphoproliferative malignancy was the most commonly encountered (63%) with an equal male to female ratio. In addition, 4 male patients with "hairy-cell" leukaemia were shown to have a B-cell disorder. T-cell disorders were found in 3 male patients; 1 patient had acute lymphoblastic leukaemia and in the other 2 the histopathological diagnosis was well-differentiated lymphoma and Sternberg sarcoma. Four patients with "null" cell lymphoma were found, the histopathological diagnoses in all were poorly-differentiated lymphocytic lymphoma, and 3 of the 4 patients were males. Further haematological investigations of the B-cell and the non-B-cell disorders showed that although the bone marrow was equally extensively infiltrated in both groups, the non-B-cell disroders were more commonly associated with complications of anemia and thrombocytopenia. It is therefore postulated that the abnormal lymphoid cell involved in B-cell disorders is an end-stage cell and not the haemopoietic stem cell.

Serum beta-lipoprotein and other specific protein concentrations were measured in 56 patients suffering from multiple myelomatosis, "benign" paraproteinaemia or Waldenström's macroglobulinaemia and in 56 control subjects. The mean level of B-lipoprotein in untreated patients with multiple myelomatosis and macroglobulinaemia was significantly lower than that of the controls. Patients who responded to chemotherapy showed a rapid return to normal of the beta-lipoprotein concentration, while the level remained unchanged in most of those who did not.

In Bantu subjects with iron overload iron is visible in skeletal muscle cells and in the tissue histiocytes which lie between these cells. In the present study the concentrations of ;muscle' iron were measured chemically in subjects with varying hepatic storage iron concentrations. The results indicate that the concentrations of storage iron in ;muscle' are much lower than those in the liver. However, the muscle mass is so large that the total amount of iron present is at least equal to that in the liver in subjects with normal body stores. The concentrations of iron in ;muscle' are raised in subjects with iron overload but the degree to which they rise is far less than occurs in the liver; a thirtyfold increase in hepatic iron concentrations is associated with only a sixfold increase in ;muscle' iron. Experiments in rats revealed that storage iron in ;muscle' represents a relatively non-miscible pool which responds very little to acute changes in the iron environment.

Studies of the ascorbic acid status in two subjects with idiopathic haemochromatosis and in 12 with transfusional siderosis showed that all had decreased levels of white cell ascorbic acid. The urinary excretion of ascorbic acid was also diminished in those subjects in whom such measurements were made. The administration of ascorbic acid was followed by only a small rise in the urinary ascorbic acid output, while the oxalic acid levels (measured in two subjects) showed a significant rise. These findings resemble those described in siderotic Bantu, and support the thesis that increased iron stores lead to irreversible oxidation of some of the available ascorbic acid.