Vertebral osteomyelitis associated with cat-scratch disease

We describe a patient with vertebral osteomyelitis and paravertebral soft-tissue collections associated with cat-scratch disease (CSD). Diagnosis was established on the basis of histologic examination and serological and polymerase chain reaction (PCR) tests. Treatment consisted of administration of antibiotics, and although skeletal lesions were persistently evident on radiography the patient showed complete clinical recovery. In addition, 15 cases of documented osteomyelitis associated with CSD are reviewed

Variations in colonic H-2 and CO2 production as a cause of inadequate diagnosis of carbohydrate maldigestion in breath tests

Background: Lactose maldigestion is usually diagnosed by means of the H-2 breath test. When C-13-lactose is used as substrate, a (CO2)-C-13 breath rest can be performed simultaneously. In an earlier publication we described the relation between both the H2 and (CO2)-C-13 exhalation in breath and the measured intestinal lactase activity after consumption of C-13-lactose. We found a discrepancy between both breath test results in 36% of the cases. To investigate the possible cause of these incongruous breath test results, we studied gas production from carbohydrate in the colon, using C-13-lactulose as a non-absorbable substrate. Methods: Experiments were performed in 21 subjects, by applying 5 different doses of C-13-lactulose. Repeatability studies were performed in six of these subjects, using 10 g substrate (three tests with I-week intervals). Results: Both the H-2 and the (CO2)-C-13 excretion in breath varied strongly interindividually and intraindividually after consumption of C-13-lactulose. In both cases no dose-response relation was observed. A significant positive linear relationship was found between Hz and (CO2)-C-13 exhalation (r = 0.45, P <0.005). Extrapolation of these results to C-13-lactose breath tests indicates that the colonic contribution of (CO2)-C-13 production to the total (CO2)-C-13 excretion in breath varies but is on the average large enough to cause false-negative (CO2)-C-13 breath test results. Conclusions: Excretion in breath of (CO2)-C-13 produced in the colon during a C-13-lactulose breath test correlates with the breath Hz excretion. This could explain the occurrence of false-negative (CO2)-C-13 lactose breath tests when colonic gas production is high and false-negative lactose Ha breath test results when gas production is low. It can also explain the improved sensitivity of the combined H-2/(CO2)-C-13 lactose breath rest compared with both breath tests alone

Variations in colonic H-2 and CO2 production as a cause of inadequate diagnosis of carbohydrate maldigestion in breath tests

Background: Lactose maldigestion is usually diagnosed by means of the H-2 breath test. When C-13-lactose is used as substrate, a (CO2)-C-13 breath rest can be performed simultaneously. In an earlier publication we described the relation between both the H2 and (CO2)-C-13 exhalation in breath and the measured intestinal lactase activity after consumption of C-13-lactose. We found a discrepancy between both breath test results in 36% of the cases. To investigate the possible cause of these incongruous breath test results, we studied gas production from carbohydrate in the colon, using C-13-lactulose as a non-absorbable substrate. Methods: Experiments were performed in 21 subjects, by applying 5 different doses of C-13-lactulose. Repeatability studies were performed in six of these subjects, using 10 g substrate (three tests with I-week intervals). Results: Both the H-2 and the (CO2)-C-13 excretion in breath varied strongly interindividually and intraindividually after consumption of C-13-lactulose. In both cases no dose-response relation was observed. A significant positive linear relationship was found between Hz and (CO2)-C-13 exhalation (r = 0.45, P <0.005). Extrapolation of these results to C-13-lactose breath tests indicates that the colonic contribution of (CO2)-C-13 production to the total (CO2)-C-13 excretion in breath varies but is on the average large enough to cause false-negative (CO2)-C-13 breath test results. Conclusions: Excretion in breath of (CO2)-C-13 produced in the colon during a C-13-lactulose breath test correlates with the breath Hz excretion. This could explain the occurrence of false-negative (CO2)-C-13 lactose breath tests when colonic gas production is high and false-negative lactose Ha breath test results when gas production is low. It can also explain the improved sensitivity of the combined H-2/(CO2)-C-13 lactose breath rest compared with both breath tests alone