Gut permeability to lactulose and mannitol differs in treated Crohn's disease and celiac disease patients and healthy subjects

The gut barrier monitors and protects the gastrointestinal tract from challenges such as microorganisms, toxins and proteins that could act as antigens. There is evidence that gut barrier dysfunction may act as a primary disease mechanism in intestinal disorders. The aim of the present study was to evaluate the barrier function towards sugars after the appropriate treatment of celiac disease and Crohn's disease patients and compare the results with those obtained with healthy subjects. Fifteen healthy volunteers, 22 celiac disease patients after 1 year of a gluten-free diet, and 31 Crohn's disease patients in remission were submitted to an intestinal permeability test with 6.0 g lactulose and 3.0 g mannitol. Six-hour urinary lactulose excretion in Crohn's disease patients was significantly higher than in both celiac disease patients (0.42 vs 0.15 percent) and healthy controls (0.42 vs 0.07 percent). Urinary lactulose excretion was significantly higher in celiac disease patients than in healthy controls (0.15 vs 0.07 percent). Urinary mannitol excretion in Crohn's disease patients was the same as healthy controls (21 vs 21 percent) and these values were significantly higher than in celiac disease patients (10.9 percent). The lactulose/mannitol ratio was significantly higher in Crohn's disease patients in comparison to celiac disease patients (0.021 vs 0.013) and healthy controls (0.021 vs 0.003) and this ratio was also significantly higher in celiac disease patients compared to healthy controls (0.013 vs 0.003). In spite of treatment, differences in sugar permeability were observed in both disease groups. These differences in the behavior of the sugar probes probably reflect different mechanisms for the alterations of intestinal permeability.

A avaliacao terapeutica da oxamniquine na esquistossomose mansoni humana pelo metodo do oograma por biopsia de mucosa retal.

Foram estudados 113 pacientes infectados pelo S. mansoni, adultos com forma hepato-intestinal da helmintiase,afastados ha mais de um ano do foco e, em geral, intensamente parasitados. A oxamniquine , adquirida diretamente nas farmacias, foi administrada a estes pacientes, na dose unica de 15 a 18 mg/kg,por via oral. Para avaliar a eficiencia terapeutica do medicamento o Autor recorreu a tecnica do oograma por biopsia de mucosa retal, realizado antes e entre o 4o. e 8o. mes apos o tratamento. Encontrou-se um porcentual de curas de 38,3%, com 6l,7% de recididas, resultados que divergem dos demais Autores. Sao comentados, atraves da analise dos oogramas quantitativos realizados em cinco pacientes, as possiveis respostas para a divergencia dos resultados de avaliacao terapeutica obtidos pelo Autor, e com os demais Autores. Segundo a opiniao do Autor, a terapeutica especifica da esquistossosome esta longe do ideal e, muito menos representa a oxamniquine medicamento de valor na terapeutica da mansoniase

Esofagetomia sub-total, com anastomose esofago-gastrica cervical transmediastinal, sem toracotomia, para tratamento de megaesofago. / Sub-total esophagectomy, with transmediastinal esophago-gastric cervical anastomosis without thoracotomy, for megaesophagus treatment

O autor mostra sua experiencia no tratamento cirurgico do megaesofago, em 20 pacientes, submetidos a esofagetomia sub-total com anastomose esofago-gastrico cervical, sem toracotomia. Os pacientes foram selecionados de acordo com o grau de ectasia esofageana e nas recidivas