[Lactose malabsorption diagnosis with H2 breath test]. / Medida do H2 expirado no diagnóstico da má absorção de lactose.

One hundred and five healthy subjects under investigation for lactose malabsorption were enrolled in this prospective study. After an overnight fast, breath was collected immediately before and every 15 minutes for three hours after an oral administration of 50 g lactose dissolved in 200 mL of water (lactose overload). Blood samples were also collected before and 20, 40 and 60 minutes after the lactose overload for blood glucose determination. Expired H2 was measured by gas chromatography using a Quintron Microlyser and the maximum increase in H2 (delta-H2) was calculated. The area under the curve (ASC-H2) was also calculated using the trapezoid model. Lactose malabsorption was defined as a maximum increase in blood glucose (delta-G) under 18 mg%. The sensibility (S), specificity (E) and accuracy (A) of the H2 determination was analyzed using (a) linear regression [log (ASC-H2) = 4.034-0.029. delta-G], (b) receiver operating curve (ROC) and by (c) Q-Q plot of the cubit root transformation of the ASC-H2 values. Our results demonstrate that ASC-H2, but not delta-H2, correlates with delta-G, suggesting that the measurement of maximum increase in H2 expired following a lactose overload is not reliable for the diagnosis of lactose malabsorption. The cutoff value for the ASC-H2 using linear regression was 3260 (S = 89.3%, E = 80% and A = 86.7%), while using ROC it was 3353 (S = 88.0%, E = 80.0% and A = 85.7%) and while using Q-Q plot method it was 2936 (S = 92.0%, E = 80.0% and A = 88.6%). When the cutoff value was set to 3000, the sensibility, specificity and accuracy were 90.7%, 80.0% and 88.6%, respectively. We conclude that the calculation of the ASC-H2, but not delta-H2, following a lactose overload is reliable in detecting lactose malabsorption and can be used in the clinical practice.

Diagnostic value of fecal leukocytes in chronic bowel diseases.

To evaluate the importance of fecal leukocytes, 42 patients who showed signs of fecal leukocytes (++ or +++) were studied. Their endoscopic examinations with biopsy and/or radiology of the colon showed the following diagnoses: 33 had ulcerative colitis, four had colonic adenocarcinoma, two had Crohn's disease, two had amebic colitis and one had eosinophilic colitis. The presence of fecal leukocytes allowed for the diagnosis of colon disease in all the patients, and it might indicate exudative bowel disease. These results suggest that whenever fecal leukocytes are found in the feces, an examination for colon disease should be made.

Possible discrimination between genotypes of lactase persistence phenotype

A persistência da atividade da lactase na vida adulta tem sido aceita como um fenótipo autossômico dominante. Uma investigaçäo da frequência da hipolactasia do tipo adulto em caucasóides brasileiros sugere, entretanto, que, entre os indivíduos capazes de absorver lactose, os homozigotos podem ser distinguidos dos heterozigotos. Um teste de tolerância à lactose foi realizado em 88 voluntários adultos, sendo a glicemia determinada em amostras de sangue venoso colhido antes e 20, 40 e 60 minutos depois do teste. Ao invés da esperada distribuiçäo bimodal, a distribuiçäo do aumento máximo da glicemia (MBGR) dos indivíduos examinados sugeriu trimodalidade correspondente a três fenótipos: a hipolactasia do tipo adulto (MBGR menor que 16 mg%), a persistência da atividade da lactase heterozigótica (MBGR entre 16 e 56 mg%) e a persistência da lactase homoizigótica (MBGR igual ou superior a 56 mg%). A distribuiçäo observada e a esperada de acordo com a lei de Hardy e Weinberg mostraram bom ajustamento

[Use of fiber enriched biscuit in the treatment of chronic intestinal constipation]. / Uso de biscoito rico em fibras no tratamento da constipação intestinal crônica.

Fiber rich cereal brans have been used for the therapeutic treatment of intestinal constipation. To improve acceptability and routine use, cookies were produced from fresh corn pericarp containing 23.3% of dietary cookies. The therapeutic effect of such cookies on simple intestinal constipation was evaluated. 8 individuals with chronic intestinal constipation and without other gastrointestinal diseases were selected. Each individual was given two diets, each of them during a seven day period: first, "normal diet" and, second, "normal" diet supplemented with 100 g of the cookies, i.e., with an increase of 23 g of dietary fiber per day. The cookies produced an increase in the frequency of evacuation (from 0.27 to 0.81 times/day), in fecal weight (from 38.3 to 117.4 g of feces/day), in water content of the feces (from 29.1 to 91.0 g of water/day), in the dry matter of the feces (from 9.1 to 26.4 g/day), and in the fiber content of the feces (from 1.59 to 8.52 g/day). As the addition of the cookies to the diet promoted increases in all fecal parameters studied, they could be considered an option in the treatment of intestinal constipation.

[Absorption of medium chain triglycerides in patients with blind loop syndrome]. / Absorção de triglicérides de cadeia média em pacientes com síndrome de alça estagnada.

Absorption of medium chain triglycerides (MCT) was estimated in 10 patients with stagnant loop syndrome (SLS). Six patients had steatorrhea due to gastrojejunal anastomosis and 4 due to diabetic neuropathy. The diagnosis of SLS was confirmed by antibiotic therapeutic test after exclusion of other causes of malabsorption syndrome. Each patient was submitted to 2 types of diet during one week each, differing only in the type of added lipid. In the diet with long chain triglycerides (LCT), soy oil and butter were added. In the diet, with medium chain triglycerides, only MCT oil from babaçu was added. The excretion of lipid was determined in the feces in the last 3 days of each diet. The results showed that the medium fecal lipid excretion was 48.6 (sd = 19.8) g/d in the LCT diet and 26.6 (sd = 13.8) g/d in the MCT [d = 22.0; s(d) = 3.10; t = 7.10; p less than 0.001], which indicates that in patients with SLS, MCT diet was better absorbed than LCT diet. It is suggested that MCT oil may be used as a caloric source during nutritional recovery in SLS.

[Qualitative microscopic evaluation of fecal fats. Comparative study]. / Avaliação microscópica qualitativa da gordura fecal. Estudo comparativo.

Microscopical examination of stool fat is an easy laboratory procedure a long ago used as screening for steatorrhea. Quantitative analysis of stool fat is accepted as the best method to diagnose fat malabsorption, but stool collection and the laboratory technique are more difficult and time-consuming. The main objective of this work was performed to compare the accuracy of microscopical qualitative examination in the same fecal sample collected in 500 patients, 299 adults and 201 children, for the three days quantitative method. The diagnosis of steatorrhea was confirmed by chemical determination in 237 adults (stool fat values greater than 5 g) and 131 children (stool fat values greater than 2 g). From these 62 patients adults and 70 children were admitted as controls. The study showed that microscopical qualitative fat evaluation is highly comparable with findings obtained by chemical dosage. However, it is important to consider the use of two microscopic examination for each fecal sample, that must be carefully homogenized.

[Isoniazid acetylation in Gilbert's syndrome]. / A acetilação da isoniazida na síndrome de Gilbert.

Phenotyping of isoniazid acetylators in 19 Caucasoid patients with Gilbert's syndrome was achieved by evaluating the percentual of acetylisoniazid in the urine. The proportion of slow acetylators among the patients with Gilbert's syndrome was similar to those found among Caucasoids of control group. The conclusion was that Gilbert's syndrome doesn't interfere in the hepatic capacity of isoniazid acetylation.

Deficiencia de lactase intestinal e intolerancia ao leite. / Intestinal lactase deficiency and milk intolerance

As industrias de laticinios tem estimulado o aumento do consumo de leite per capita em todas as partes do mundo. Entretanto, a maioria das populacoes humanas, inclusive a brasileira, sao compostas de pessoas que manifestam perda progressiva de lactase intestinal apos o desmame. Em consequencia, tais pessoas perdem a capacidade de digerir e absorver o acucar do leite (lactose) e podem sofrer perturbacoes digestivas de gravidade variavel apos a ingestao de leite. Alem disso, a ingestao de leite pode ser desastrosa para criancas hipolactasicas subnutridas das regioes tropicais, visto que elas sao mais frequentemente expostas a infeccoes gastrointestinais. O presente trabalho e uma revisao sobre a natureza da deficiencia de lactase do tipo adulto, as consequencias da hipolactasia, os metodos para avaliar a atividade da lactase, as caracteristicas geneticas da hipolactasia do tipo adulto e os estudos brasileiros sobre hipolactasia

[Gilbert's syndrome in patients with splenomegaly]. / Síndrome de Gilbert em pacientes com esplenomegalia.

Three patients are reported with hyperbilirubinemia and splenomegaly. The diagnosis of Gilbert's syndrome was made by the caloric restriction test and enzymatic induction test. The splenomegaly was attributed to spherocytosis in two patients, while the third case had a probable diagnosis of spherocytosis.

[Primary lactose malabsorption in healthy Brazilian adult caucasoid, negroid and mongoloid subjects]. / Mabsorção primária de lactose em brasileiros adultos caucasóides, negróides e mongolóides sadios.

A lactose tolerance test consisting of the administration of 50 g lactose as a 10% aqueous solution was applied to 80 healthy adult individuals from Campinas, SP., Brazil (40 caucasoids, 20 negroids and 20 mongoloids of Japanese ancestry) with no secondary lactase deficiency. Lactose malabsorption was manifested by 45% caucasoids, 85% negroids and 100% mongoloids. The lactose malabsorption as assessed by the lactose loading test was more closely associated with symptoms of lactose intolerance (cramps, meteorism and diarrhea) than with fecal alterations (acid pH, as well as detectable glucose and reducing substances in the feces).

Mabsorcao primaria de lactose em brasileiros adultos caucasoides, negroides e mongoloides sadios. / Primary lactose malabsorption in healthy Brazilian adult caucasoid, negroid and mongoloid subjects

Oitenta brasileiros adultos e sadios de Campinas, SP., Brasil (40 caucasoides, 20 negroides e 20 mongoloides - descendentes nao miscigenados de japoneses), sem deficiencia secundaria de lactase, submeteram-se a um teste de tolerancia a lactose, que consistiu da administracao de 50% g desse acucar em solucao aquosa a 10%. A mabsorcao de lactose foi manifestada por 45% dos caucasoides, 85% dos negroides e 100% dos mongoloides. A deficiencia de lactase do tipo adulto, averiguada por intermedio do teste de sobrecarga de lactose mostrou-se mais fortemente associada aos sintomas de intolerancia a lactose (colicas, meteorismo e diarreia), do que a alteracoes fecais (pH acido e presenca de glicose e de substancias redutoras nas fezes)

Sindrome de Gilbert em pacientes com esplenomegalia. / Gilbert's syndrome in patients with splenomegaly

Sao descritos tres pacientes com ictericia e esplenomegalia. Os testes de restricao calorica e da inducao enzimatica permitiram estabelecer o diagnostico de sindrome de Gilbert. A esplenomegalia foi atribuida a esferocitose, cujo diagnostico foi de certeza em dois casos e provavel no terceiro caso