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Biomedical subjects

H S Heymans

Publications and source records attributed to H S Heymans.

At least 19 recordsLinked to original sources
PubMed1996

The value of the D-xylose test compared with the differential sugar absorption test in recognizing coeliac disease.

OBJECTIVE: To compare the value of the differential sugar absorption test (SAT) with the blood and urine D-xylose tests (DXTs and DXTu) in diagnosing coeliac disease (CD) the SAT and the standard DXTs and DXTu were performed in 14 coeliacs with abnormal small bowel histology and in 12 patients with aspecific gastrointestinal complaints. METHODS: In the SAT a solution of lactulose (L) and mannitol (M) was given to the fasting patient after which the L/M ratio was measured in 5 h urine by gas chromatography. In the DXTs and DXTu a solution of 25 g D-xylose was given to the fasting patient and blood was drawn at 0, 30 and 120 min and urine was collected for 5 h, respectively. RESULTS: To measure the power in diagnosing CD of the SAT, DXTs 30 min, DXTs 120 min and DXTu, the test results were plotted in ROC curves and the areas under the curves (AUCs) were calculated. The AUCs were 0.97, 0.77, 0.78 and 0.63, respectively. CONCLUSION: In our opinion, the DXTs and DXTu are no longer useful in the investigation of mucosal function of the small bowel.

Adult↗
PubMed1996

Adenosine triphosphate-dependent copper transport in human liver.

BACKGROUND/AIM: The recent cloning and sequencing of the Wilson disease gene indicates that hepatic copper (Cu) transport is mediated by a P-type ATPase. The location of this Cu-transporting protein within the hepatocyte is not known; in view of its proposed function and current concepts of hepatic Cu transport, it may reside in intracellular membranes (endoplasmic reticulum (ER), lysosomes) and/or in the bile canalicular membrane. The objective of this study was to establish characteristics and localization of ATP-dependent Cu transport in human liver. METHODS: We have investigated Cu transport in vesicles of human liver plasma membranes showing a gradual increase in enrichment of canalicular domain markers: i.e. basolateral liver plasma membranes (blLPM), a mixed population of basolateral and canalicular (XLPM) and canalicular liver plasma membranes (cLPM). RESULTS: In the presence of ATP (4 mM) and an ATP-regenerating system, uptake of radiolabeled Cu (64Cu, 10 microM) into cLPM vesicles and, to a lesser extent, into blLPM and XLPM was clearly stimulated when compared to control AMP values. Initial uptake rates of ATP-dependent Cu transport were 5.6, 7.8 and 13.7 nmol.min-1.mg-1 protein for blLPM, XLPM and cLPM, respectively, and showed no relationship with marker enzyme activity of ER and lysosomes (glucose-6-phosphatase and acid-phosphatase, respectively). Leucine aminopeptidase activity, as a marker for the cLPM, significantly correlated with ATP-dependent uptake rates measured in different membrane preparations: r = 0.70 (n = 9, p < 0.05). Estimated K(m) and Vmax values of ATP-dependent Cu uptake were 49.5 microM and 36.9 nmol.min-1.mg-1 protein, respectively. CONCLUSION: This study provides biochemical evidence for the presence of an ATP-dependent Cu transport system in human liver (cCOP), mainly localized at the canalicular domain of the hepatocytic plasma membrane.

Adenosine Triphosphate↗
PubMed1996

Follow-up of treated coeliac patients: sugar absorption test and intestinal biopsies compared.

OBJECTIVE: To determine whether the sugar absorption test (SAT) during follow-up of patients with coeliac disease on a gluten-free diet (GFD) correlates with improvement of the villous architecture of the small intestine. METHODS: The SAT was performed in coeliacs at diagnosis and during follow-up with GFD. For the SAT, a solution of lactulose (L) and mannitol (M) was given to the fasting patient and the L-M ratio calculated in a 5-hour urine sample by gas chromatography: ratios > 0.089 are considered abnormal. The solution was made hyperosmolar by adding sucrose (1560 mmol/l). RESULTS: The L-M ratio was 2-3 times higher at diagnosis than either at 8 months to 2 years gluten free, or beyond 2 years gluten free, consecutively. The L-M ratio (mean, range) was significantly higher in cases of biopsies with (sub)total villous atrophy (VA) (0.388, 0.062-0.804, n = 28), partial VA (0.240, 0.062-0.841, n = 18) and villous irregularity (0.143, 0.017-0.322, n = 29) than in case of normalized histology after GFD (0.085, 0.021-0.230, n = 19). The rate of normalization of functional integrity was slower in adults than in children, demonstrated by a combination of histology and SAT. CONCLUSION: The SAT correlates well with the degree of VA. It is important for daily clinical practice that the simple and non-invasive SAT can be used as an indicator of intestinal damage, thus influencing need for and timing of intestinal biopsies.

Adolescent↗
PubMed1996

Current concepts and issues in the management of regurgitation of infants: a reappraisal. Management guidelines from a working party.

Regurgitation in infants is a common problem. Recent issues, such as the increased risk of sudden infant death in the prone sleeping position, the finding of persisting occult gastro-oesophageal reflux with feed thickeners, and the increasing awareness of the cost-benefit ratio of medications may challenge the currently recommended management approach. A round table was organized to elaborate on the impact of (i) the pro supine sleeping campaigns in relation to sudden infant death and (ii) advancement in medical treatment on therapeutic strategies in regurgitating infants. The participants were opinion leaders from Europe and North America (Belgium, Canada, France, UK, Italy, Switzerland and The Netherlands). The importance of parental reassurance is stressed. As a consequence of the supine sleeping campaigns aiming to decrease the incidence of sudden infant death syndrome, the "prone elevated sleeping position" is no longer advised as a first-line therapeutic approach, although it is still recommended in "complicated reflux". It is emphasized that milk thickeners are an adequate therapeutic tool for regurgitation, but not in reflux disease. According to the literature, the efficacy of (alginate )antacids, although very popular in some countries, is questionable. These recommendations will be of interest to first-line paediatricians, since about 40% of their patients, according to the literature, present because of regurgitation.

Anti-Ulcer Agents↗
PubMed1996

Use of tracheal auscultation for the assessment of bronchial responsiveness in asthmatic children.

BACKGROUND: It can be difficult to assess bronchial responsiveness in children because of their inability to perform spirometric tests reliably. In bronchial challenges lung sounds could be used to detect the required 20% fall in the forced expiratory volume in one second (FEV1). A study was undertaken to determine whether a change in lung sounds corresponded with a 20% fall in FEV1 after methacholine challenge, and whether the occurrence of wheeze was the most important change. METHODS: Fifteen children with asthma (eight boys) of mean age 10.8 years (range 8-15) were studied. All had normal chest auscultation before the methacholine challenge test. Lung sounds were recorded over the trachea for one minute and stored on tape. They were analysed directly and also scored blindly from the tape recording by a second investigator. Wheeze, cough, increase in respiratory rate, and prolonged expiration were assessed. RESULTS: The total cumulative methacholine dose causing a fall in FEV1 of 20% or more (PD20) was detected in 12 children by a change in lung sounds - in four by wheeze and in eight by cough, increased respiratory rate, and/or prolonged expiration. In two subjects altered lung sounds were detectable one dose step before PD20 was reached. In three cases in whom no fall in FEV1 occurred, no change in lung sounds could be detected at the highest methacholine dose. CONCLUSION: Changes in lung sounds correspond well with a 20% fall in FEV1 after methacholine challenge. Wheeze is an insensitive indicator for assessing bronchial responsiveness. Cough, increase in respiratory rate, and prolonged expiration occurs more frequently.

Adolescent↗
PubMed1996

Intestinal permeability in exocrine pancreatic insufficiency due to cystic fibrosis or chronic pancreatitis.

Disturbances of the intestinal integrity, reflected by an increased intestinal permeability, are reported in cystic fibrosis (CF). Controversy exists whether the increased intestinal permeability is due to CF itself or a consequence of the concomitant exocrine pancreatic insufficiency (PI). We measured intestinal permeability by the sugar absorption test in 32 PI patients: 20 CF-PI, 12 nonCF-PI with chronic pancreatitis, and 50 controls. In the sugar absorption test, the lactulose/mannitol ratio is measured in 5-h urine samples after oral ingestion of a solution of lactulose and mannitol, hyperosmolar by the addition of sucrose. The lactulose/mannitol ratio was increased in both CF-PI and nonCF-PI versus controls (p < 0.0001). In CF, the L/M ratio and permeability for lactulose and mannitol did not change by increasing pancreatic enzyme supplementation by 30-50% for 2 wk (p = 0.74, p = 0.97, p = 0.74, respectively) nor by decreasing the osmolarity of the test solution by 75% (p = 0.24, p = 0.10, p = 0.39, respectively). We conclude that an increased intestinal permeability in CF is probably a consequence of PI and is not related to the dose of pancreatic enzyme supplementation nor the osmolarity of the test solution. The increase is due to an increased permeability for lactulose which might point toward a defect in the tight junctions of the villi and/or crypts. The cause of the increased intestinal permeability in the presence of PI is still unclear. An increased intestinal permeability points toward an impaired functional integrity of the small bowel, which may contribute to gastrointestinal dysfunction in CF.

Adolescent↗
PubMed1996

Phenylketonuria: plasma phenylalanine responses to different distributions of the daily phenylalanine allowance over the day.

OBJECTIVE: To achieve smooth control of plasma phenylalanine concentrations in phenylketonuric patients, it is advocated to divide the daily intake of natural protein and amino acid supplements equally over the meals. However, this may be quite an encumbrance for the patient. We, therefore, investigated whether a breakfast with an unequal daily distribution results in an undue rise in the plasma phenylalanine concentration. DESIGN: Plasma phenylalanine concentrations were measured in seven patients with phenylketonuria in response to three tests with breakfast and lunch, representing an equally or unequally divided daily distribution of the individually tailored phenylalanine intake. Breakfast contained 25%, 50%, or 75%, whereas lunch contained 30% or 10% of the individual daily phenylalanine allowance, respectively. RESULTS: Plasma phenylalanine concentrations showed postprandial increases of up to 26% above baseline. Generally, phenylalanine returned to baseline during the test and remained within the target range if baseline phenylalanine was within that range. Two patients having values in the upper target range showed a rise just above the target range for 60 minutes on an unequal daily distribution of phenylalanine. In another patient treated similarly, plasma phenylalanine did not return to baseline during the test. CONCLUSIONS: Unequal distributions of the daily phenylalanine allowance are justified, provided that the patient is in good clinical condition, adjusted to the diet adequately, and the daily allowance is not exceeded. At this time, however, we cannot recommend this unequal daily distribution for daily practice.

Adolescent↗
PubMed1995

[Standardized multidisciplinary diagnosis of cow's milk protein allergy in children. Work Group Cow's Milk Protein Allergy of the Groningen Academic Hospital].

OBJECTIVE: Evaluation of standardized multidisciplinary diagnostic procedures for cow's milk allergy (CMA) in children. DESIGN: Prospective standardized study. SETTING: Beatrix Children's Hospital, Department of Allergology, Dermatology and Dietetics, University Hospital Groningen, the Netherlands. METHODS: From August 1991 until May 1993, 114 children suspected of CMA for the first time were investigated according to the protocol for diagnosis of CMA, together with 23 children, previously diagnosed as CMA, in whom CMA was re-evaluated. Of 114 children with first suspicion of CMA, 66 improved on a cow's milk-free diet. The remaining 48 were excluded from the study because of no improvement on a cow's milk free diet, no diet given, insufficient data or no follow-up. The protocol was evaluated by questionnaire sent to 10 representatives of the departments involved. RESULTS: In 26/66 (39%) children, the diagnosis of CMA was confirmed by cow's milk challenge. The eosinophilic granulocytes were higher (p = 0.04), both IgE RAST and Skin Prick Test (SPT) for cow's milk were more often positive (both p = 0.01) in CMA than in non-CMA. The sensitivity and specificity were 50%-82% for IgE RAST and 60%-84% for the SPT, respectively. Four of the 23 children still had CMA at re-evaluation. In three of them, a SPT was performed, which was positive in all. In 12 of the 19 children, without CMA at re-evaluation, a SPT was performed, which was negative in all. At 1, 2, 3 and 4 years of age 13%, 48%, 74% and 78%, respectively, of the re-evaluation CMA patients had developed tolerance for cow's milk. The use of the protocol was found important by the representatives involved, although some practical difficulties remain. CONCLUSION: A multidisciplinary approach of CMA is possible. Improvement on a cow's milk-free diet by itself is not sufficient to diagnose CMA. Cow's milk challenge is obligatory. Laboratory investigations are of limited value. Re-evaluation of CMA after one year of age is necessary in view of the temporary character of CMA. When the SPT for cow's milk is positive, postponement of re-evaluation may be considered.

Allergens↗
PubMed1995

Repeatability of the sugar-absorption test, using lactulose and mannitol, for measuring intestinal permeability for sugars.

Differential sugar-absorption tests for measuring intestinal permeability for sugars have been studied in a variety of gastrointestinal diseases. Their use in general practice has been hampered by a lack of data on reference values and repeatability of the test and the laboratory assay. In this study, we determined the reference values of the sugar-absorption test, using lactulose and mannitol as probe molecules, for children and adults. The repeatability of the test is good; linear relationship: slope, 0.825 [95% confidence interval (CI), 0.571, 1.152); intercept, 0.005 (95% CI, -0.004, 0.010). The repeatability of the laboratory assay for the sugar-absorption test is excellent; linear relationship: slope, 1.014 (95% CI, 0.870, 1.094); intercept, 0.002 (95% CI, -0.005, 0.010). The validation of the sugar-absorption test makes the test useful as a simple, noninvasive, reliable intestinal permeability test for sugars, which can be of use for clinical practice. Taking possible interfering factors into account, the sugar-absorption test can be used as a diagnostic test for enteropathy of different etiologies and evaluation of therapeutic interventions in both children and adults. Studies with the sugar-absorption test may clarify the role of intestinal permeability in the pathophysiology of a variety of gastrointestinal diseases.

Adolescent↗
PubMed1995

Home care in cystic fibrosis patients.

Intravenous antibiotics and enteral tube feeding at home for the treatment of pulmonary exacerbations and underweight condition in cystic fibrosis (CF) patients have become tools that are used in many cystic fibrosis centres. The experience with home care programmes from different countries is quite conclusive. If the necessary preparations are made, such as training of staff and patients, and financial support is arranged, home care is easy to put into practice. Optimal patient compliance is also necessary. Home care is as effective as hospital treatment for selected patients, and less expensive. Experience has increased during many treatment periods in different cystic fibrosis centres, and only a few adverse events have been recorded, indicating that home care is safe. However, the most important gain for cystic fibrosis patients is the reduction of hospital admission time, which means a definite improvement in the quality of life.

Anti-Bacterial Agents↗
PubMed1995

Physical adaptation of children to life at high altitude.

Children permanently exposed to hypoxia at altitudes of > 3000 m above sea level show a phenotypical form of adaptation. Under these environmental conditions, oxygen uptake in the lungs is enhanced by increases in ventilation, lung compliance, and pulmonary diffusion. Lung and thorax volumes in children growing up at high altitude are increased. The haemoglobin concentration in highlanders is elevated. With respect to the decreased arterial oxygen tension at high altitude, this seems a useful adaptation. Blood viscosity also increases as a result of the increase in red blood cell concentrations however, and this has potentially negative effects on the microcirculation in the tissues. The decreased partial pressure of oxygen in the lungs of highland children is associated with a higher pulmonary artery pressure. Pulmonary hypertension, high altitude pulmonary oedema, and chronic mountain sickness form part of the pathophysiology afflicting highland dwellers. Birth weight at high altitude is decreased. Decreased postnatal growth has been widely reported in populations at high altitude, particularly in early studies from the Andes. Recent studies taking into account the effects of socio-economic deprivation, suggest that long-term exposure to altitudes of 2500-3900 m is associated with a moderate reduction in linear growth in children.

2,3-Diphosphoglycerate↗
PubMed1995

Symptomatology and growth in infants with cow's milk protein intolerance using two different whey-protein hydrolysate based formulas in a Primary Health Care setting.

Both growth and the course of allergic symptoms were evaluated in 79 infants with cow's milk protein intolerance, aged three months or younger, diagnosed by standard elimination/provocation and treated with a whey-hydrolysate based infant formula: Nutrilon Pept or Pepti Junior. The efficacy of both products, in terms of symptomatology and growth, was compared with each other. The products differ in fat source (Pepti Junior 50% of its fat as MCT, Nutrilon Pepti normal LCT fat blend) and the presence of lactose (Pepti Junior: lactose free; Nutrilon Pepti: 40% of its carbohydrate as lactose). The study was part of a large project that aimed at standardising the approach towards cow's milk protein intolerance in Baby Health Clinics. Nearly 50 Baby Health Clinics participated in this project. In this study, growth and symptomatology (skin, respiratory tract, gastrointestinal tract) were monitored during an intervention period of at least 10 weeks. Infants in both feeding groups showed normal growth, and in at least 80% of the infants an improvement of the overall symptomatology could be seen during the intervention period. Most profound were the decreases in prevalence and severity of eczema and infantile colic. No differences in efficacy were found in this study between the two infant formulas. It was concluded that the exclusive use of either whey hydrolysate based infant formula resulted in an improvement of allergic symptoms and in normal growth in infants diagnosed by elimination/provocation for cow's milk protein intolerance in a Primary Health Care setting.

Growth Disorders↗
PubMed1994

[A new biscuit free of cow's milk, chicken egg protein, lactose and gluten for children with food hypersensitivity].

OBJECTIVE: Evaluation of the clinical reaction of 10 children with food allergy, including allergy to cow's milk protein, to the introduction of a new biscuit, free of cow's milk protein, chicken egg protein, lactose and gluten. DESIGN: Descriptive prospective study. SETTING: Outpatient clinic, Beatrix Children's Hospital, University Hospital Groningen. METHOD: In 10 patients (mean age 28 months, range 13-78 months) with a proven cow's milk protein allergy the new biscuit (25 biscuits of 15.5 g each in 2 weeks) was introduced without otherwise changing the diet. The clinical symptoms, total serum IgE, the IgE radio-allergosorbent test (RAST), the skin test, the intestinal permeability (measured with the sugar absorption test), and energy and nutrient intake were determined before and after the introduction of the biscuits. Results were evaluated by the Wilcoxon test. RESULTS: Laboratory results were not significantly different between the groups. A recurrent clinical reaction was seen in one patient after consumption of a biscuit (probably due to a potato component). During the period of biscuit consumption energy and nutrient intake were increased in all children when a maximum of 1.5 biscuit per day was consumed. CONCLUSION: No problems were seen in 9/10 children following introduction of the new biscuit. Energy and nutrient intake were improved. An allergic reaction was seen in 1/10 children, probably due to the potato component.

Child↗