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Biomedical subjects

S B Heymsfield

Publications and source records attributed to S B Heymsfield.

At least 253 records · Page 14Linked to original sources
PubMed1981

Measurement of liver and spleen volume by computed tomography. Assessment of reproducibility and changes found following a selective distal splenorenal shunt.

Liver and spleen size were measured in 11 normal subjects and 12 patients with cirrhosis. Volume was calculated by adding together the area measurements obtained from successive transverse abdominal scans. The normal mean volume of the liver (+/- S.D.) was 1,493 +/- 230 cm3 and that of the spleen was 219 +/- 76 cm3; interobserver variability was 4-8% and the day-to-day coefficient of variation was 6-10%. In cirrhotic patients studied prior to and 7-10 days after a distal splenorenal shunt, the mean liver volume fell from 1,642 to 1,529 cm3 (p less than 0.06) and the mean spleen volume from 660 to 507 cm3 (p less than 0.006), supporting the use of such a shunt in selective decompression of varices and maintenance of portal hypertension. This is a clinically useful method of measuring organ volume with the required sensitivity.

Adult↗
PubMed1981

Enteral versus parenteral nutritional support in cancer patients.

There are many theoretical and practical advantages to enteral rather than parenteral administration of nutrients. However, it is unlikely that enteral supplementation of nutritional intake as presently practiced will be successful as a primary therapy for most patients with the cancer cachexia syndrome. The most likely role of enteral nutritional support (ENS) is in conjunction with other therapies. This modality deserves evaluation in surgery with curative intent. Changes in diet are effective in reducing the gastrointestinal symptoms of abdominopelvic irradiation, but the effect of ENS on the hematologic toxicity of radiation therapy and on response rates and survival is unclear. Elemental diets can reduce the gastrointestinal toxicity of conventional doses of 5-FU, but they worsen the mortality and hematologic toxicity of higher doses. Factors such as protein, fat, and carbohydrate sources, degree of hydrolysis of protein, lactose content, and timing of dietary manipulations are important in evaluating the response to ENS.

Animals↗
PubMed1981

Total parenteral nutrition as an adjunct to chemotherapy of metastatic colorectal cancer.

A randomized study was performed in advanced cancer to test the effectiveness of total parenteral nutrition (TPN) in maintaining and improving nutrition, to examine the effects of TPN on tumor growth, and to determine if TPN altered chemotherapy response rates, treatment tolerance, and survival. Forty-five patients on identical chemotherapy were randomized to TPN versus ad libitum feeding. TPN was well tolerated. No clinical or tumor marker evidence suggesting neoplastic growth stimulation was obtained. Chemotherapy-related complications and chemotherapy responses did not differ between the two groups. TPN had little effect on performance status. TPN patients gained an average of 2.8 kg before chemotherapy, but triceps skinfold and mid-arm muscle area did not change significantly during TPN. Survival did not improve with TPN. We conclude that current techniques of TPN are of limited benefit in advanced colon cancer. A small subset of patients with short-gut malabsorption may be helped. Further study is needed to determine the mechanisms of cancer undernutrition and to refine nutritional supplementation techniques on the basis of these mechanisms.

Adenocarcinoma↗
PubMed1981

Effect of total parenteral nutrition on survival in advanced colon cancer.

To determine if total parenteral nutrition (TPN) with constant infusion of hypertonic glucose and amino acids by central vein (35 kcal/kg/day) would influence survival in advanced colorectal carcinoma, 50 patients were randomized to receive either chemotherapy alone or the same drugs plus TPN for 14 days before treatment and a variable period thereafter. Overall median survival was significantly decreased in the TPN patients (79 vs 305 days, P = 0.03). Survival was significantly decreased in the TPN patients who had lost the least percentage of premorbid weight (0-6%) (66 vs 398 days, P = 0.02), and in all TPN males (61 vs 209 days, P = 0.03), when compared to similar controls. TPN did not increase survival in any patient subcategory. Catheter-related and metabolic complications were uncommon. We conclude that TPN as used in this study did not prolong median survival in the group as a whole, and may have shortened survival in males and in patients with little or no prior weight loss.

Adolescent↗
PubMed1980

Mitral valve prolapse and ophthalmoplegia: a progressive, cardioneurologic syndrome.

Disorders characterized by both neurologic (ataxia, ophthalmoplegia, ptosis, neuromyopathy) and cardiologic (heart block, cardiomyopathy) abnormalities have been previously called the "ophthalmoplegia plus" syndromes. Most are not due to a specific enzyme defect or metabolic abnormality and thus may be similar phenotypic expressions of diverse causes. We studied seven patients with progressive external ophthalmoplegia and variable ataxia, with mitral valve prolapse and mitral regurgitation that progressed in severity as did the neuromuscular manifestations. Abnormal skeletal muscle biopsies showed "ragged-red" fibers or congenital fiber type disproportion; serum alanine levels were elevated; in-vivo and in-vitro tests of pyruvate metabolism gave abnormal results; C4 complement was decreased; and the patients' fibroblasts bound immunoglobulin when incubated with autologous serum. These data suggest a distinct neuromuscular disorder with metabolic and immunologic features associated with mitral valve prolapse and progressive mitral regurgitation.

Adult↗
PubMed1979

Hypertrophic cardiomyopathy and human leukocyte antigen linkage: differentiation of two forms of hypertrophic cardiomyopathy.

To determine whether hypertrophic cardiomyopathy is associated with a human leukocyte antigen (HLA) phenotype, we tissue-typed 70 unrelated afflicted patients and 86 of their asymptomatic family members (from nine separate kindreds). Forty-five per cent of the white patients had B-12 antigen as compared to 23 per cent in matched control subjects; 69 per cent of black patients had a B-5-complex antigen as compared to 33 per cent in matched controls. Patients with a B-12 or B-5-complex antigen were nonhypertensive and had family members with the disease. Patients without these antigens were severely hypertensive and had no affected family members. Linkage analysis of six families revealed a lod score of 7.7 for asymmetric septal hypertrophy and the HLA region of chromosome 6. We conclude that there is a heritable, nonhypertensive form of hypertrophic cardiomyopathy linked to the HLA loci on chromosome 6 and that a sporadic form is associated with severe, systemic hypertension.

Adult↗
PubMed1979

A radiographic method of quantifying protein-calorie undernutrition.

Estimation of midarm adipose tissue and muscle by the anthropometric technique is based on the idealized assumption that the arm and its muscle compartments are circular, and that fat is distributed evenly around the arm. We examined the validity of these assumptions by computerized axial tomography of the midarm in 21 subjects ranging from 65 to 255% of ideal body weight. Computerized axial tomography identified three errors inherent in the anthropometric method: 1) The arm and its muscle compartment were rarely circular, but resembled instead an ellipse and "cloverleaf", respectively; 2) fat was distributed asymmetrically around the arm, and furthermore when triceps skinfold was less than 5 mm, no fat was radiographically detectable, and 3) muscle are calculated by the anthropometric method includes bone area. Since bone area was not influenced by nutritional status, anthropometric "muscle area" underestimated the degree of muscle atrophy in undernutrition. Despite these limitations, in subjects 60 to 120% of ideal body weight anthropometric estimates of midarm muscle area (MAMA) and fat area did not differ greatly from the radiographic values. Anthropometric MAMA was consistently greater than the radiographic value by 15 to 25%, while midarm fat area agreed within +/- 10%. The error in the anthropometric MAMA could be nearly eliminated by two types of correction: expressing MAMA as a percentage of normal, and correcting for bone content by subtracting midarm bone area (6.3 and 4.7 cm2 for men and women). In subjects greater than 150% ideal body weight, however, anthropometric estimates of MAMA and midarm fat area differed from the radiographic values by greater than 50% even after the above two types of correction. Midarm computerized axial tomography scan provides an accurate alternative to the anthropometric method for estimating midarm muscle and fat in these obese individuals.

Adipose Tissue↗
PubMed1979

Nasogastric hyperalimentation through a polyethylene catheter: an alternative to central venous hyperalimentation.

We performed nasogastric hyperalimentation with polyethylene catheters and appropriate feeding solutions in 12 cachectic patients who had been referred as candidates for central venous hyperalimentation. Most patients had primary gastrointestinal disease. The duration of hyperalimentation averaged 31 days. Seven patients obtained rapid weight gain (average 0.3 kg/day) with the nasogastric hyperalimentation alone. An additional two were successfully repleted with the addition of parenteral fluids via peripheral veins. In the nine repleted patients, serum albumin rose by average 19%, 24-hr urine creatinine by average 21%, and triceps skinfold by average 46%. The nature of the weight gain in the nine successful cases was analyzed by the metabolic balance study technique. Average composition of the increment in weight was: 50% protoplasm, 48% extracellular fluid, 19% adipose tissue, and less than 1% bone. We conclude that nasogastric hyperalimentation can replace central venous hyperalimentation in a substantial proportion of patients now receiving the latter type of treatment.

Adult↗
PubMed1979

Neurogenic skeletal myopathy in patients with primary cardiomyopathy.

Eleven patients with hypertrophic obstructive cardiomyopathy and eight patients with idiopathic congestive cardiomyopathy underwent extensive neuromuscular studies to determine if a skeletal myopathy is associated with uncomplicated primary cardiomyopathy. The clinical examination revealed peripheral neuropathies in six patients, but no evidence of muscle weakness or atrophy. Nerve conduction studies demonstrated a neuropathy in five of these six and in one other patient: three were in the hypertrophic group and three in the congestive group. Seven patients had abnormal electromyography, but none had characteristic myopathic changes. Of these seven patients, muscle biopsies showed denervation in two patients in the congestive group and type II atrophy in two patients in the hypertrophic group. We found no evidence of primary skeletal muscle involvement; however, neuropathic features and biopsy changes of denervation were present in both groups.

Adult↗
PubMed1979

Enteral hyperalimentation: an alternative to central venous hyperalimentation.

Severe protein-energy undernutrition is a frequent finding among chronically ill patients. Its causes are anorexia, hypermetabolism, and malabsorption. Adverse consequences include impaired cell-mediated immunity increased susceptibility to infection, poor wound healing, weakness, and death. Spontaneous oral intake is inadequate in patients with this disorder, and therapeutic maintenance or repletion alimentation is needed. Enteral hyperalimentation is the method of choice, if tolerated. A successful treatment program usually requires a small-bore, flexible nasoenteral tube, appropriate feeding solution, and constant flow delivery of nutrient. If only partial dietary requirements are tolerated enterally, peripheral intravenous nutrient solutions can often supply the deficit. Although not suitable for all patients, enteral hyperalimentation is more physiologic, safer, easier, and more economical than central venous hyperalimentation. It would be well tolerated by many patients who now receive nutritional repletion by the latter method.

Humans↗
PubMed1979

Accurate measurement of liver, kidney, and spleen volume and mass by computerized axial tomography.

Computerized axial tomography permits accurate cross-sectional radiographic visualization of visceral organs. Thus, "radiographic area" of an organ slice can be calculated and converted to actual area from a standard grid printed on the roentgenogram. Because the width between slices is known, the volume of an organ slice can be calculated as area times width. Mass of the organ slice is then the product of slice volume and organ density, and entire mass of the organ is the sum of the masses of all the organ slices. The validity of this method was examined in four water-filled balloons, in 12 excised human cadaver organs (six kidneys, three livers, and three spleens), and in two human cadavers while the organs (four kidneys, one liver, and two spleens) remained in situ. Radiographic volume and mass agreed with actual volume and mass within +/- 3% to 5%, thus confirming the accuracy of this method.

Humans↗
PubMed1978

Sequence of cardiac changes in Duchenne muscular dystrophy.

Boys with Duchenne muscular dystrophy (DMD) rarely have clinical evidence of myocardial dysfunction during life. Nevertheless, congestive heart failure is a frequent terminal event and autopsy invariably shows dystrophic myocardial involvement. Little is known regarding the progression of heart functional abnormalities in boys with DMD from birth to death. Therefore we have examined the hearts of 18 DMD boys aged 4 to 15 years with the following non-invasive methods: cardiovascular physical examination, electrocardiography, chest x-ray, serum enzymes, and echocardiography. Control subjects were 25 normal boys matched to their DMD counterparts by age and by body surface area. The dystrophic patients were divided into early (N = 9) and late (N = 9) DMD according to manual muscle testing of skeletal muscles. In early DMD, six of 23 cardiac indices differed from control boys; in the late stage, an additional five indices became abnormal. Early DMD was characterized by these abnormalities: tachycardia, large ECG R/S ratio in V1, augmented q wave voltages in Leads I, II, and V5 of the ECG, diminished contractile excursion of the left venticular posterior wall (LVPW) and interventricular septum, and decreased rate of relaxation of the LVPW. In late DMD additional cardiac abnormalities appeared: enlarged heart volume by x-ray, reduced cardiac ejection fraction, diminished change in left ventricular diameter from diastole to systole, reduced maximal systolic endocardial velocity, and decreased rate of circumferential fiber shortening as detected in the echocardiogram. Most of the cardiac abnormalities were revealed only by echocardiography, which is thus shown to be a sensitive method for monitoring the progression of cardiac dystrophy during the life span of the DMD child.

Adolescent↗