The malabsorption of commonly occurring mono and disaccharides: levels of investigation and differential diagnoses.

BACKGROUND: Adverse food reactions (AFR) have has recently attracted increased attention from the media and are now more commonly reported by patients. Its classification, diagnostic evaluation, and treatment are complex and present a considerable challenge in clinical practice. Non-immune-mediated types of food intolerance have a cumulative prevalence of 30% to 40%, while true (immune-mediated) food allergies affect only 2% to 5% of the German population. METHOD: We selectively searched the literature for pertinent publications on carbohydrate malabsorption, with special attention to published guidelines and position papers. RESULTS: Carbohydrate intolerance can be the result of a rare, systemic metabolic defect (e.g., fructose intolerance, with a prevalence of 1 in 25,000 persons) or of gastrointestinal carbohydrate malabsorption. The malabsorption of simple carbohydrates is the most common type of non-immune-mediated food intolerance, affecting 20% to 30% of the European population. This condition is caused either by deficient digestion of lactose or by malabsorption of fructose and/or sorbitol. Half of all cases of gastrointestinal carbohydrate intolerance have nonspecific manifestations, with a differential diagnosis including irritable bowel syndrome, intolerance reactions, chronic infections, bacterial overgrowth, drug side effects, and other diseases. The diagnostic evaluation includes a nutritional history, an H2 breath test, ultrasonography, endoscopy, and stool culture. CONCLUSION: The goals of treatment for carbohydrate malabsorption are to eliminate the intake of the responsible carbohydrate substance or reduce it to a tolerable amount and to assure the physiological nutritional composition of the patient's diet. In parallel with these goals, the patient should receive extensive information about the condition, and any underlying disease should be adequately treated.

The detection of calcium pyrophosphate crystals in sequential synovial fluid examinations of patients with osteoarthritis: once positive, always positive.

The aim of this study was to investigate whether calcium pyrophosphate dihydrate (CPPD) crystals are constantly detectable in sequential synovial fluid (SF) examinations of patients with initially CPPD-positive osteoarthritis (OA). For this purpose, we searched our SF database for CPPD-positive patients, who had two or more SF analyses between 2008 and 2012 to get sequential information. The database contains SF data determined by a standardised procedure. Of 1,878 samples, examined within the defined time period, 60 samples from sequential SF analyses of 23 patients were eligible for this study. The number of examinations ranged from 2 to 7 (median, 2), and the median interval between the first and last arthrocentesis was 12 months (2-43). CPPD crystals were detected in all of the sequentially examined samples according to the defined criterion of positivity. All of the subjects had OA of the knee, with a median Kellgren-Lawrence grade of 3 in the initially performed X-rays, and meniscal calcifications were found in six subjects. In conclusion, our results suggest that CPPD crystals are a regular feature of sequentially examined SF of initially CPPD-positive patients with symptomatic OA of the knee.

Diffractive incremental and absolute coding principle for optical rotary sensors.

Rotary sensors are an essential component in numerous applications where a rotation movement has to be detected. With optical encoders, a high angular resolution can be achieved. As a disadvantage, the resolution enhancement is associated with increasing cost. To overcome this issue, a coding principle is presented that uses a diffractive solid measure on a microstructured plastic disc. Like a DVD, this encoder disc can be manufactured in a cost effective injection molding process. For this approach, a differential incremental code, as well as an absolute code, has been developed.

Congenital absence of the portal vein in an adult woman: a case report.

Congenital absence of the portal vein is a rare malformation. Mesenteric and splenic venous blood bypasses the liver and drains into the renal veins or directly into the inferior vena cava. The malformation occurs predominantly in females and children and is often associated with other anomalies such as hepatic tumors, cardiac malformations and skeletal abnormalities. We describe a 23-year-old female with congenital absence of the portal vein associated with variant origin of the hepatic artery from the superior mesenteric artery. Additional anomalies were not present. The patient is in good condition. Laboratory tests showed elevated total bilirubin; other liver parameters were within normal range. The absence of the portal vein was confirmed by MR angiography, which revealed that the upper part of the superior mesenteric vein and the splenic vein drained into the left renal vein. A liver biopsy showed no signs of cirrhosis. Yearly follow-up with laboratory tests and ultrasonography was recommended to our patient. According to the literature, the prognosis of this patient depends on the presence of cardiac defects and liver tumors. There is little information on the outcome of patients with congenital absence of the portal vein; only long-term follow-up investigations will provide answers to the numerous remaining questions.