Hepatic granulomatosis in a patient with Graves' disease.

We report a case of granulomatous hepatitis in a patient with hyperthyroidism resulting from Graves' disease. A 30-year-old man presented with massive weight loss, jaundice, tachyarrhythmia and goitre. Liver function tests showed mild cytolysis and cholestasis and massive hyperbilirubinaemia. The echogram of liver and bile ducts was normal and no infection was found. A liver biopsy revealed a mixed cytolytic and cholestatic hepatitis with intralobular epithelioid granulomas. No specific cause was identified, and sarcoidosis and primary biliary cirrhosis were ruled out. The outcome was favourable with antithyroid therapy and short-term glucocorticoid therapy, and the patient was totally free of symptoms after 2 years. To our knowledge, this is the first case of granulomatous hepatitis to be reported in association with Graves' disease. The clinical evolution of the liver disease paralleled the evolution of hyperthyroidism.

[Multiple granular cell tumor of the colon]. / Tumeur à cellules granuleuses colique plurifocale.

With reference to a case of multiple colorectal granular cell tumors, the authors briefly review the literature concerning this unusual tumor localization. This case demonstrates the most common appendicular, caecal and rectal forms among the localizations of colonic granular cell tumors: as well as the possible proliferation of many other tumors especially in caecal localizations. However the course of the disease is slow, and at the present time only one case report of malignant colonic TCG has been published.

[Lactase deficiency and lactose intolerance-related symptoms in adult healthy subjects from western France]. / Déficit en lactase et symptômes d'intolérance au lactose dans une population adulte saine originaire de l'ouest de la France.

The prevalence of lactase deficiency (LD) and lactose intolerance is not well known in France. Using breath hydrogen and methane analysis after 50 g oral lactose load, we investigated the prevalences of LD, lactose intolerance, and methane producer status in 102 healthy adults born in western France, and we examined the relationships between these parameters and the daily milk consumption. In 10 subjects with LD and lactose intolerance, we studied the reproducibility of the lactose hydrogen breath test results for the diagnosis of LD and lactose intolerance and estimated the quantity of lactose malabsorbed in comparison with the lactulose hydrogen breath test. The prevalence of LD was 23.4 percent and symptoms of lactose intolerance were observed in 50 percent of the 24 subjects with LD. The daily milk consumption was not significantly different in the 24 subjects with LD and in the 78 subjects without LD (281 +/- 197 vs 303 +/- 217 ml/24 h). The prevalence of methane producer status was 42.1 percent. The symptomatic group of lactose malabsorbers (n = 12) was characterized by a shorter lactose mouth to caecum transit time (39 +/- 20 vs 88 +/- 48 min; P less than 0.05), and more marked hydrogen production (6.1 +/- 2.3 vs 3.4 +/- 2.4 10(3) ppm.min; P less than 0.04). In the 10 subjects with LD and lactose intolerance, the hydrogen breath test was reproducible for diagnosis of LD and lactose intolerance, and for hydrogen production. The quantity of lactose malabsorbed was 60 percent. In France, symptoms of lactose intolerance are not severe and do not affect the daily consumption of milk and dairy products.

Breath hydrogen response to lactulose in healthy subjects: relationship to methane producing status.

In order to assess the relationship between methane (CH4) producing status and the breath excretion of hydrogen (H2) in healthy subjects, breath CH4 and H2 were simultaneously measured for 14 hours after oral ingestion of 10 g lactulose in 65 young volunteers. Forty were breath CH4 producers and 25 were not. Statistically significant differences were observed between both groups, with lower values for CH4 producers recorded for the following parameters: fasting basal value of breath H2 (8.1 (4.9) v 5.2 (3.7) ppm, p less than 0.05), mouth-to-caecum transit time (68 (24) v 111 (52) min, p less than 0.005), and breath H2 production measured as area under the curve 13.1 (6.9) v 8.8 (3.8) 10(3) ppm/min, p less than 0.02). There was no significant correlation between individual production of breath H2 and CH4. These results indicate that the response to lactulose depends on breath CH4 producing status. In clinical practice, defining normal values of mouth-to-caecum transit time without knowledge of breath CH4 producing status may lead to misinterpretation of the H2 breath test.

Pasta cooking time: influence on starch digestion and plasma glucose and insulin responses in healthy subjects.

The influence of pasta cooking time on starch digestion and plasma glucose and insulin responses was studied in 12 healthy subjects. During 3 consecutive days, one of three pasta test meals (50 g starch) cooked for 11, 16.5, and 22 min was served to each volunteer in a random order. Hydrogen and methane breath excretion was measured after pasta ingestion; plasma responses were compared with those of an equivalent oral glucose-tolerance test. No significant differences were found between cooking times and plasma indices, orocecal transit time, or incremental hydrogen excretion (delta peak hydrogen). With one exception, pasta meals that were completely absorbed were ingested by methane producers. Postprandial delta peak hydrogen was significantly lower in methane than in nonmethane producers (p less than 0.02). These results point to a lack of influence of cooking time on nutritional characteristics of pasta and suggest that starch malabsorption determined by breath-hydrogen-test criteria may be underestimated in methane producers.