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Biomedical subjects

R J Brummer

Publications and source records attributed to R J Brummer.

At least 55 records · Page 3Linked to original sources
PubMed1995

Adipose tissue assessed by magnetic resonance imaging in growth hormone-deficient adults: the effect of growth hormone replacement and a comparison with control subjects.

The visceral and subcutaneous abdominal adipose tissue (AT) area and the subcutaneous hip AT area were assessed by magnetic resonance imaging (MRI) in 12 growth hormone-deficient adults before and after 6 mo of replacement with recombinant human growth hormone (rhGH) and in 12 healthy control subjects. The data obtained by MRI were compared with circumference measurements of waist and hip. Growth hormone-deficient patients compared with control subjects had a higher visceral AT area (P = 0.003) and subcutaneous AT area (P = 0.013); there was no significant difference in subcutaneous hip AT area. Six months of rhGH replacement reduced the subcutaneous hip AT area (19.8%), the subcutaneous abdominal AT area (15.6%), and particularly the visceral AT area (38.2%), resulting in fat areas that were not different from those of control subjects. Furthermore, this study shows that in contrast with control subjects, circumference measurements are not useful to predict AT areas in growth hormone-deficient patients and cannot be used to assess changes in AT areas during rhGH replacement.

Adipose Tissue↗
PubMed1995

Direct assessment of extracellular water volume by the bromide-dilution method in growth hormone-deficient adults.

Body composition and water content were assessed in 36 growth hormone deficient (GHD) patients (M:23, F:13) and 14 controls (M:7, F:7) using anthropometry, hydrodensitometry, bioelectrical impedance measurement and the bromide-dilution method, with which extracellular water volume can be measured directly. GHD patients, compared to controls, did not differ in extracellular water volume, in hydration state and water distribution. A higher BMI (P = 0.002) and a higher body fat mass (P < 0.0001) were found in the patients. Based on circumference measurements, the GHD patients had a higher waist/hip ratio (P = 0.0001). This study shows that GHD patients, in comparison with healthy controls, have a normal extracellular water volume. The finding that extracellular water volume is within the normal range in GHD patients may be clinically relevant as it is well known that in the first months after initiating GH-replacement therapy, most patients have signs and symptoms of excessive water retention.

Adult↗
PubMed1995

Validation of extracellular water determination by bioelectrical impedance analysis in growth hormone-deficient adults.

We validated the determination of extracellular water (ECW) by the bioelectrical impedance method (BIA), using the RJL manufacturer-supplied equation and the equation of Lukaski in 34 growth hormone-deficient (GHD) patients before and after replacement with recombinant human growth hormone (rhGH), using the bromide-dilution (Br-) method as the reference method. At baseline, paired comparisons showed no significant differences between mean ECW assessed by the Br- method and by BIA using both equations in the placebo and rhGH group. At 6 months, no significant difference was found between ECW assessed by the Br- method and by BIA using the manufacturer-supplied equation, both in the placebo and rhGH group. High coefficients of reliability (0.88-0.98) and high correlations (0.79-0.98; p < 0.001) were found between ECW assessed by the Br- method and by BIA applying two different regression equations in the placebo and rhGH groups at baseline and after 6 months. Mean differences in ECW assessed by the Br- method and BIA were between 2.6 and 4.1% of the mean ECW determined by the Br- method at baseline and between 2.7 and 8.5% after 6 months. Multiple comparisons showed a significantly greater ECW assessed by the Br- method than by BIA using the equation of Lukaski (p < 0.0001). This difference was found in the placebo and rhGH replacement group. The difference changed with time (p = 0.005), indicating that the usefulness of the formula of Lukaski seems to be affected by rhGH replacement therapy. We conclude that the noninvasive BIA technique might be a useful method to predict ECW in GHD patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Resting metabolic rate, body composition and related hormonal parameters in growth hormone-deficient adults before and after growth hormone replacement therapy.

The resting metabolic rate (RMR), and body composition were assessed in 30 growth hormone-deficient (GHD) adults before and after 3 and 6 months of replacement therapy with recombinant human growth hormone (rhGH). In addition, insulin-like growth factor I (IGF-I), IGF binding proteins (IGFBPs) and plasma insulin were measured at baseline and at 6 months in relation to RMR. During 6 months of rhGH replacement therapy, body fat decreased from 18.2 +/- 1.5 (mean +/- SEM) to 14.3 +/- 1.6 kg (p < 0.0001), whereas fat-free mass (FFM) increased from 53.5 +/- 3.3 to 56.3 +/- 3.6 kg (p < 0.0001), RMR increased from 1246 +/- 92 to 1539 +/- 102 kcal/24 h (p < 0.0001) and RMR per kilogram of FFM increased from 23.2 +/- 0.6 to 27.4 +/- 0.5 (p < 0.0001). When RMR data were adjusted for the differences in FFM, it appeared that apart from the increase in FFM, other factors may play a role in the increase in RMR. During rhGH replacement therapy, IGF-I (p < 0.0001) and IGFBP-3 (p = 0.003) levels increased, whereas IGFBP-1 levels decreased significantly (p = 0.004). The FFM explained for about 80% of the variance in RMR. In addition, waist/hip ratio and plasma IGF-I contributed significantly to the explained variance of RMR. This study shows that in GHD adults FFM is the main determinant of RMR and that, next to the increase in FFM, changes in metabolic and hormonal parameters contribute to the increase in RMR during rhGH replacement therapy.

Adult↗
PubMed1995

Energy and macronutrient intake in growth hormone-deficient adults: the effect of growth hormone replacement.

OBJECTIVE: To assess the energy intake and the macronutrient composition of the diet in 25 growth hormone-deficient (GHD) patients before, and after 3 and 6 months replacement with recombinant human growth hormone (rhGH). DESIGN: The study had a randomised double-blind placebo-controlled design. Energy intake was assessed by the 4-day food record and 24-h urine total nitrogen excretion was used as a check on the validity. The energy and macronutrient intake of the GHD patients at baseline were compared with the data obtained in the Dutch Nutritional Survey. Fat-free mass (FFM) and body fat (BF) were assessed by bioelectrical impedance analysis (BIA). Plasma thyroid hormones and insulin-like growth factor-I (IGF-I) were studied in relation to energy and macronutrient intake. SETTING: Department of Endocrinology, University Hospital Utrecht, Utrecht, The Netherlands. SUBJECTS: 25 GHD patients, aged 21-60 years. RESULTS: GHD adults, compared to controls, have a lower energy intake. During the first 3 months of rhGH replacement therapy, there is a trend for energy intake to increase, no change in macronutrient intake, whereas plasma T3, IGF-1 and FFM increase and body weight does not change, hence BF decreases. The positive relationship between the increase in energy intake and the rise in plasma total T3 level during rhGH replacement therapy indicates that in addition to the GH-induced changes the increase in energy intake and specifically in carbohydrate intake might contribute to the enhanced conversion of thyroxine. Protein intake calculated from the 4-day food record was significantly correlated with protein intake calculated from 24-h urine nitrogen. CONCLUSION: GHD patients have a lower energy intake. Notwithstanding the fact that FFM and plasma T3 increase and body weight does not change, a significant increase in energy intake is not found with the use of the 4-day food record method.

Adolescent↗
PubMed1994

Eosinophilic enterocolitis diagnosed by means of technetium-99m albumin scintigraphy and treated with budesonide (CIR).

A patient with a 15 year history of diarrhoea of unknown origin is described. Scintigraphy with technetium-99m labelled albumin suggested albumin loss at the terminal ileum and caecum; subsequent colonoscopic biopsies of these macroscopically normal looking areas showed abundant infiltration with eosinophils. A diagnosis of eosinophilic enterocolitis was made. Treatment with prednisolone had good results, but had to be stopped because of severe side effects. Oral cromoglycate and mesalazine were not effective. Budesonide (CIR), a new topically active corticosteroid with very little systemic effects, was at least as effective as prednisolone without producing side effects.

Adult↗
PubMed1993

Glutamine and the preservation of gut integrity.

Parenteral glutamine dipeptide improves nitrogen balance in postoperative patients on total parenteral nutrition (TPM). Animal studies show that the structure and function of the gut is preserved by glutamine. It is not known if this is the case in human beings. 20 patients admitted to hospital for total parenteral nutrition were randomly allocated to receive parenteral nutrition enriched with glycyl-L-glutamine (Gln TPN), or standard parenteral nutrition (STPN). Mucosal biopsy specimens were taken from the second part of the duodenum before starting parenteral nutrition, and after two weeks. The ratio between the urine concentrations of lactulose and mannitol after enteral administration was used to measure intestinal permeability. After two weeks of parenteral nutrition in the GlnTPN group, intestinal permeability was unchanged, whereas permeability in the STPN group increased. Villus height was unaltered in the GlnTPN group but in the STPN group it decreased. The addition of glutamine to parenteral nutrition prevents deterioration of gut permeability and preserves mucosal structure.

Adult↗
PubMed1993

Adipose tissue and muscle volume determination by computed tomography in acromegaly, before and 1 year after adenomectomy.

The adipose tissue volume, skeletal muscle and skin volume and visceral organ volume were determined using the multiscan CT (computed tomography) technique in 15 patients with acromegaly. The examinations were performed before treatment and 1 year after transsphenoidal adenectomy. The mean body weight did not change significantly after treatment; 91.3 kg and 92.3 kg pre and postoperatively in men and 66.7 kg and 65.9 kg in women respectively. The total adipose tissue volume increased by 7.11 (59.2%, P < 0.01) in the male group and 3.9 1 (20.3%, P < 0.05) in the female group. Muscle and skin mass and visceral organ mass decreased significantly after treatment. The muscle and skin mass decreased by 3.6 1 (-7.4%, P < 0.01) in males and by 3.2 1 in females (-11.5%, P < 0.02). The corresponding decrease in visceral organ mass was 1.5 1 (-17.0%, P < 0.01) in males and 1.0 1 (15.4%, P < 0.05) in females respectively. On average, the fractions of adipose tissue in the subcutaneous trunk and the intra-abdominal depots increased after treatment, while the fractions of adipose tissue in the limbs and the head and neck region decreased. The change in adipose tissue distribution pattern reached significance (P < 0.005) in men only.

Acromegaly↗
PubMed1993

Gastric asthma? No change in respiratory impedance during intraesophageal acidification in adult asthmatics.

BACKGROUND: In patients with asthma, gastroesophageal reflux (GER) has been shown to be a common finding, and a number of investigators have suggested that reflux may have a deleterious effect in asthma, either as a result of recurrent (micro)aspiration or by some form of a reflex mechanism. AIM OF THE STUDY: To measure changes in lung function in response to intraesophageal acid perfusion in asthmatics with GER. METHODS: In 12 patients with bronchial asthma and complaints suggesting GER with increased reflux scores during 24-h intraesophageal pH monitoring, impedance measurements of the respiratory system using the technique of forced oscillations and spirometry were performed after intraesophageal acidification. RESULTS: No statistically significant changes in FEV1 or in respiratory impedance were demonstrated after intraesophageal acid provocation. CONCLUSION: No direct effect of intraesophageal acidification on bronchomotor tone was demonstrated in asthmatics with GER.

Administration, Inhalation↗
PubMed1993

Lactose malabsorption. Optimalization of investigational methods.

Although the prevalence of lactose malabsorption is high and the importance of this diagnosis is established in gastroenterological practice, still a variety of poorly standardized tests is used to investigate the ability of the small bowel to digest lactose. In this report the various most commonly used lactose malabsorption tests are described and compared with each other knowing that a 'gold standard' does not exist. The hydrogen breath test is the test most used in clinical practice. On the basis of recent investigations the recommendation is made to improve the accuracy of this test by prolonging it to 4 hours and by simultaneous measuring of the oro-coecal transit time.

Blood Glucose↗
PubMed1992

Effects of growth hormone on fat mass and fat distribution.

GH has profound effects on the amount and distribution of adipose tissue. GHD in both children and adults is accompanied by an increased amount of adipose tissue and by the abdominal predominance of adipose tissue. In contrast, treatment with GH reduces adipose tissue, and redistributes adipose tissue from abdominal to peripheral depots.

Acromegaly↗
PubMed1992

Validation of body composition determination by bioelectrical impedance analysis in acromegaly.

Body composition determination by bioelectrical impedance analysis (BIA) has been compared with measurement of total body water (TBW) by tritiated water dilution and estimation of body fat (BF) by measurement of TBW and total body potassium (TBK) in a four-compartment model, in patients with acromegaly. This disorder is accompanied by a profound aberration in body composition. Furthermore TBW and BF were predicted on the basis of anthropometric variables alone. Paired comparisons of TBW estimations by isotope dilution and BIA showed good correlation (Spearman's rank correlation 0.95, P less than 0.01). Isotope dilution resulted in a mean of 1.7 liter (standard deviation 1.87) higher values. Comparison of BF estimations showed also a significant correlation (Spearman's rank correlation 0.75, P less than 0.01), with slightly higher values for BIA (mean 1.4 kg; standard deviation 2.99). BIA improved the prediction of TBW and BF compared with predictions based on anthropometric variables. In a population of acromegalic patients, BIA seemed to be a useful method to estimate TBW and BF.

Acromegaly↗
PubMed1990

Growth hormone and body composition.

Through its anabolic, lipolytic and antinatriuretic actions, GH has profound effects on body composition. In untreated acromegaly, body weight, body cell mass and extracellular water are increased simultaneously with a decrease of body fat. After successful treatment, extracellular water and body fat normalize, but cell mass remains high. The changes in cell mass, body fat and extracellular water observed in acromegaly suggest different dose-response relationships between GH and these parameters. The relationship between GH concentration and the lipolytic actions of GH is more linear, while the relationship between GH and excess extracellular water is more curvilinear. The sodium-retaining effect of GH seems to be mediated by stimulation of the Na(+)-K+ pump. At higher GH levels, the pump activity is counteracted by an alleged sodium transport inhibitor. In GH-deficient children, GH treatment is followed by rapid loss of adipose tissue and muscular gain. The influence of GH on body composition in GH-deficient adults has recently received attention. Compared to normal subjects, these patients are overweight and have decreased cell mass. Replacement treatment with GH restores body composition towards normal.

Acromegaly↗
PubMed1989

Body composition in acromegaly: the effect of treatment.

Total body water (TBW) and total potassium (TBK) were measured in patients participating in a follow-up investigation of all acromegalic patients seen between 1956 and 1984. The results were compared with population-based estimates of TBK and TBW calculated from height (BH), weight (BW) age and sex, using data from a large number of healthy subjects (n = 476). The findings were compared with values obtained at diagnosis and were also related to growth hormone (GH) and IGF-I/SmC concentrations at follow-up. BW at follow-up was unchanged compared to BW at diagnosis and was 9.7 and 10.0 kg higher in males and females, respectively, than in healthy subjects of the same BH (BWnorm). Growth hormone concentration at follow-up correlated directly with excess extracellular fluid volume (ECW%) (P less than 0.001) and inversely with the ratio observed/predicted body fat (BF%) (P less than 0.001) as well as with BW/BWnorm (P less than 0.05). On the other hand, GH concentration did not correlate with excess body cell mass (BCM%) estimated from TBK. IGF-I/SmC concentration correlated with GH concentration at follow-up (P less than 0.001) and with ECW% (P less than 0.01) but not with BCM% or BF%. In 39 patients, data on body composition were also available at diagnosis. Of these, three males had developed gonadal insufficiency and their BCM had decreased markedly. One patient had suffered from hemiplegia. Five patients had not received any treatment. In the remaining 30 treated patients, those with a post-treatment GH concentration below 5 mU/l were normalized with respect to ECW and BF. BCM, however, was unchanged. In contrast, patients with GH concentration greater than or equal to mU/l displayed unchanged body composition. Furthermore, BH decreased significantly in successfully treated patients.

Acromegaly↗
PubMed1989

Body composition in acromegaly.

Total body water (TBW) and potassium (TBK) were measured in untreated acromegalic patients seen between 1956 and 1984 and the results were compared to values predicted from height (BH), weight (BW), age and sex, using data from a large number of healthy subjects (n = 476). Normal body weight for each patient (BWnorm) was predicted from BH and sex, the regression equations being derived from a representative population sample (n = 4017). The BH for each patient was compared with data on BH in 15,000 Swedes. The patients were significantly taller than the control population (P less than 0.001). In 107 (70%) of the 156 patients BH was above the median. Patients with an early onset of the disease were taller than those with a later onset. TBK and TBW were significantly higher than predicted from observed BW (P less than 0.001) and so was the quotient extracellular water (ECW)/intracellular water (ICW). Body fat (BF), on the other hand, was lower than predicted (P less than 0.001). Observed BW in male acromegalics was 8.1 kg higher than predicted from healthy subjects of the same BH (BWnorm), a difference explained by an average increase of 4.7 kg in body cell mass (BCM) (P less than 0.001) and 7.1 kg in extracellular water (P less than 0.001) simultaneously with a mean decrease of 3.7 kg in BF (P less than 0.01). Female acromegalics weighed on average 6.4 kg more than healthy women, a difference explained by an increase in BCM of 3.3 kg (P less than 0.001) and in ECW of 4.6 kg (P less than 0.001) concomitantly with a decrease in BF of 1.5 kg. Mean hGH concentration at diagnosis correlated inversely with the quotients observed/predicted BF (P less than 0.01) and BW/BWnorm (P less than 0.05) but not with the quotients observed/predicted TBK, TBW or ECW/ICW.

Acromegaly↗