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Biomedical subjects

N M Drayer

Publications and source records attributed to N M Drayer.

At least 37 records · Page 2Linked to original sources
PubMed1992

Shape of the craniofacial complex in children with Turner syndrome.

The shape of the craniofacial complex was established in 69 children with Turner syndrome aged between 3.5 and 16.6 years. The children had not been treated with growth hormone (GH) or anabolic steroids. On a standardized lateral roentgenencephalogram 13 linear and 7 angular variables were measured. Data of all variables were available from normal Dutch children for comparison. The main abnormalities were located in the cranial base and in the mandible and consisted of a short posterior cranial base, all increased cranial base angle and a short, retrognathic and posteriorly rotated mandible. The maxilla was smaller than normal and also slightly posteriorly rotated. The abnormalities were already present in young children with Turner syndrome. Indications were found that in Turner syndrome interstitially as well as appositionally growing cartilage is affected. The changes in the maxilla can be explained in various ways. They may be due to defective growth of the nasal cartilage or to a disorder in the intramembranous ossification of the maxilla or they may be adaptive to the changes in the cranial base and the mandible. From this study it can be concluded that patients with Turner syndrome exhibit several craniofacial abnormalities, probably due to a cartilage disorder.

Adolescent↗
PubMed1991

Bacterial contamination of growth hormone solution and injection equipment during use by growth hormone deficient children.

The frequency of bacterial contamination of growth hormone solution and injection equipment use by 20 growth hormone deficient children was studied. In a cross-over study the children were randomized to begin using, for their growth hormone injections, either the recently developed growth hormone injection pen or the conventional syringe method. A comparison was then made of these two methods of injection over a 6-week period and the vials, pen-cartridges, syringes and needles were cultured. When the pen was used 5.3% of the 114 vials, 15.5% of the 110 cartridges and 11.2% of the 98 needles were found to be contaminated; when the syringe was used 3.5% of the 113 vials, 7.1% of the 98 syringes and 9.1% of the 99 needles were contaminated. To ensure microbiological safety during the preparation and injection of the growth hormone solution, regular instruction and reassessment of the injection technique for patients on long-term treatment are advocated. This applies even when disposable items are used. As no statistically significant difference was noted between the number of contaminated items used with either the pen or the syringe method, we conclude that the growth hormone pen is suitable for growth hormone administration.

Adolescent↗
PubMed1991

Measurement of the cortisol production rate in two sisters with 17 alpha-hydroxylase deficiency using [1,2,3,4-13C]cortisol and isotope dilution mass spectrometry.

[1,2,3,4-13C]cortisol was i.v. administered to two sisters aged 11 yr (patient I) and 3 yr (patient II) who suffer from 17 alpha-hydroxylase deficiency. This is the first time that the cortisol production rate (CPR) in patients with 17 alpha-hydroxylase deficiency has been measured with a stable labelled tracer using the urinary method. The urine was collected for 3 days. High-performance liquid chromatography (HPLC) of approximately 100 ml urine extracts was carried out to isolate the small amount of cortisol metabolites excreted. The cortisol metabolites were oxidized to 11-oxo-aetiocholanolone. The isotope dilution in the methyl oxime tert-butyldimethylsilyl ether derivatives was measured by selected ion monitoring gas chromatography/mass spectrometry (GC/MS). The CPR calculated from tetrahydrocortisone (THE) and the cortolones was 765 and 536 nmol/day, respectively in patient I. The CPR in patient II was only calculated from THE and was 62 nmol/day. If radioactive labelled cortisol had been used, much larger quantities of urine would have been needed for isolation of sufficient mass of metabolites, even then purification may have been difficult. Steroid profiling of 1 ml urine samples by GC and identification by GC/MS revealed high concentrations of pregnenolone, progesterone, 11 beta-hydroxy progesterone and corticosterone metabolites. Tetrahydrocorticosterone and 5 alpha-tetrahydrocorticosterone were found in urine at elevated excretions of 2.5 and 5.7, 0.9 and 2.0 mumols/24 h, in patients I and II respectively. No cortisol metabolites were detected by routine GC or GC/MS as the low amounts excreted co-eluted with the relatively abundant corticosterone metabolites.

Adrenal Hyperplasia, Congenital↗
PubMed1990

Cortisol production rate in children by gas chromatography/mass spectrometry using [1,2,3,4-13C]cortisol.

A urinary method of determining the cortisol production rate (CPR) in children was studied under physiologic conditions by administration of low amounts of [1,2,3,4-13C]cortisol. The CPR in three patients with multiple pituitary deficiency ranged from 7 to 16 mumoles d-1 m-2, and the CPR in three patients with congenital adrenal hyperplasia (CAH) due to 11 beta-hydroxylase deficiency (11 beta OHD) and 17 alpha-hydroxylase deficiency (17 alpha OHD) from 0.1 to 2.11 mumoles d-1 m-2. Results showed that with this method, very low CPRs can be reliably measured. The metabolism of [13C4]cortisol or [9,12,12-2H]cortisol was compared with that of native cortisol in adrenalectomized piglets. For the urinary cortisol metabolites, small to substantial differences in isotope dilution were noted relative to that in the original cortisol mixture. With [13C4]cortisol, the so-called secondary isotope effects were approximately 2% to 3% for tetrahydrocortisone (THE) and tetrahydrocortisol (THF), and about 10% for the cortolones, relative to the cortisol mixture. When [2H3]cortisol was used, the cortisol metabolites THE and THF contained only two deuterium atoms. Together with this apparent loss of one deuterium atom, the secondary isotope effects in these steroids amounted to 5% to 10%. It was concluded that [13C4]cortisol was the better tracer to use for the measurement of urinary CPR.

Adolescent↗
PubMed1990

Anthropometric measurements at diagnosis of childhood cancer.

Height, weight, upper-arm circumference, sitting height, armspan, and head circumference were measured in 96 patients at diagnosis of a childhood malignancy. Height of both parents could be measured in 60 cases. Some individuals with acute lymphoblastic leukemia were very tall and some patients with a brain tumor were very small. In contrast, the mean values for height, sitting height, and midparent height were normal in all four groups of patients (with leukemia, solid tumor, brain tumors, and remaining malignancies). Armspan, however, was significantly longer in leukemia and solid tumor patients in comparison with healthy peers. These finding are not considered enough evidence for the existence of an association between tallness and childhood malignancy. Weight (for height) was significantly lower in solid tumor patients than in leukemia patients.

Adolescent↗
PubMed1989

Metabolic dissimilarity between (9,12,12-2H) cortisol and natural cortisol in vivo. Can deuterated cortisol be used for the measurement of the urinary cortisol production rate?

The metabolism of deuterated cortisol (9,12,12,-2H)cortisol, 2H3-F) was compared to that of radioactive cortisol (3H2-F) and natural cortisol, when these three compounds were administered simultaneously to an adrenalectomized piglet. The relative isotope dilution of tritium was determined from the specific activities of the main urinary neutral cortisol metabolites, tetrahydrocortisone (THE) and tetrahydrocortisol (THF), normalized to that of the cortisol mixture administered. To obtain a comparison of the isotope dilution of deuterium in the metabolites THE and THF to that in the cortisol mixture, the three steroids were converted to the common oxidation product 11-oxo-aetiocholanolone, and derivatized to the methoxime-tert-butyl-dimethylsilyl ether. The relative 2H-isotope dilution then was measured by gas chromatography/mass spectrometry. It was found that the specific activity of THE in the cumulative urine collections was similar to that of the cortisol mixture administered; the two-day value was, however, less. The specific activity of THF was slightly but significantly smaller than 1 (approximately 0.9) at all times. The relative 2H-isotope dilution in THE was slightly but significantly larger than one (approximately 1.1) at all times, whereas that in the THF was larger than 1.0 at 9 and 32 h or equal to 1.0 at 20 and 47 h of urine collection. When comparing the metabolism of the two tracer cortisol species the quotient of the 3H- and the 2H-isotope dilutions in THE and THF was smaller than 1.0. It can be concluded that (2H3)cortisol may be used for the determination of the cortisol production rate.

Adrenalectomy↗
PubMed1989

Reference values of anthropometric measurements in Dutch children. The Oosterwolde Study.

In the period 1979-1980 the following anthropometric measurements were recorded in 2351 healthy Dutch children from 0-17 years of age: height, weight, sitting height, arm span, lengths of upper-arm, lower-arm and hand, tibial length, foot length, biacromial diameter, biiliacal diameter, and head circumference. Corresponding percentile values were constructed on the basis of normality assumptions, the mean and standard deviation at age t being determined by a cubic spline approximation. The results are compared with other studies and given in the form of growth charts.

Adolescent↗
PubMed1989

Total deficiency of growth hormone and prolactin, and partial deficiency of thyroid stimulating hormone in two Dutch families: a new variant of hereditary pituitary deficiency.

Four out of 10 children in two unrelated families presented with a total pituitary growth hormone (GH) and prolactin deficiency and a partial thyrotropin (TSH) deficiency. The GH gene was intact in family I. The pituitaries, visualized by magnetic resonance imaging, were normal. All children responded well to GH and L-thyroxine therapy. Baseline plasma somatostatin and its peak response to arginine infusion were elevated in family I and they had a milder TSH deficiency than family II. Plasma insulin showed a poor response to arginine infusion. This hereditary combination of pituitary deficiencies suggests a deficiency of a common positive transcription factor.

Adult↗
PubMed1988

Are (13C)cortisol and (3H)cortisol metabolized identically to natural cortisol in adrenalectomized piglets?

Adrenalectomized piglets were intravenously administered a mixture of (13C4)cortisol and (3H)cortisol and natural cortisol to determine if the two tracers are metabolized identically to natural cortisol. Urine was collected after 0.5, 1.0, 1.5 and 2.0 days and the isotope dilution was measured in the four major urinary cortisol metabolites, namely tetrahydrocortisone (THE), tetrahydrocortisol (THF), alpha- and beta-cortolone in the cumulative urines. In contrast to other studies, because of the sensitivity of the method used to measure the 13C4 enrichment, non-cumulative urine collections were also analysed. Quantification of the 13C4 isotope enrichment was carried out by gas chromatography/mass spectrometry with selected ion monitoring. The specific activities of the metabolites from the cumulative urine collections were determined by high-performance liquid chromatography and scintillation counting. Small secondary isotope effects seemed to occur during the metabolism of (13C4)cortisol, as a decrease in isotope enrichment in all four metabolites was measured. These effects were easily observed with alpha- and beta-cortolone isolated from the cumulative urine collections; the enrichment decreased by 19% and 14%, respectively. The lowering in isotope dilution in THE observed in the 2.0 day cumulative urine collection in piglets 1 and 2 were 4% and 3%, respectively. A lowering in isotope dilution in THF in the 2.0 day cumulative urine collection could be observed in piglet 2, namely 7%, but no change in isotope dilution could be seen in piglet 1. These secondary isotope effects could only be observed in the 2 days cumulative urine, and not in the cumulative urines collected over shorter times. The non-cumulative urines collected at half-day periods showed a significant decrease in isotope dilution in THE and THF isolated from the urine collected after 1 day. No statistically significant isotope effects were observed with the metabolism of (3H)cortisol, except at 0.5 day when the specific activity in the cortolones was lower and that in THF was higher. However, at 0.5 day with THE and 1.0 day with THF and the cortolones the specific activities remained approximately 6% higher than that administered in the cortisol. Secondary isotope effects with tritiated cortisol may have occurred but because of the relatively large imprecision of the measurement (SD = 3-4% with THE and THF and the cortolones (SD approximately 8%) compared to the measurements of the 13C4 enrichment (SD approximately 2%) these effects could not statistically be proven.(ABSTRACT TRUNCATED AT 400 WORDS)

Adrenalectomy↗
PubMed1987

Determination of the urinary cortisol production rate using (1,2,3,4-13C)cortisol. Isotope dilution analyses at very small enrichments.

An isotope dilution mass spectrometric method to determine the urinary cortisol production rate (CPR) in babies and children is described. The method uses stable isotopically labelled (1,2,3,4-13C)cortisol. The tracer is intravenously administered to the patient and urine is collected for the following three days. Following extraction, enzymic hydrolysis, purification and isolation by high-performance liquid chromatography (HPLC) the urinary cortisol metabolites tetrahydrocortisone, tetrahydrocortisol, alpha- and beta-cortolone are separately oxidized the common product, 11-oxo-aetiocholanolone. The methyl oxime tert-butyldimethylsilyl ether derivative (MO TBDMS) was analysed by gas chromatography mass spectrometry. Quantification of the isotope enrichment was carried out by unlabelled, and at m/z 348 for labelled 11-oxo-aetiocholanolone. HPLC isolation of the metabolites together with the oxidation step allowed very small isotope enrichments, sometimes down to 0.1% (1:1000), to be reliably measured against a linear calibration graph containing 0 to 1% (13C4) enrichments. The standards for the calibration graph were synthesized from mixtures of labelled (13C4) cortisol and natural cortisol, and the calibration graph was prepared each time samples were measured. The long term instrumental precision of the isotope dilution analyses was 0.91% for a derivatized sample containing a (13C4) enrichment of 0.5% (measured on six different days over seven months). The coefficient of variation of the complete procedure for the four cortisol metabolites was between 1.17 and 2.14%. The clinical applicability of the method is demonstrated by presenting the results of a CPR determination in a patient.

Adolescent↗
PubMed1986

Improved gas chromatographic-mass fragmentographic assay for tetrahydroaldosterone and aldosterone in urine.

A newly devised procedure for a simultaneous determination of urinary tetrahydroaldosterone and aldosterone is described. The procedure is based on deconjugation and acetalization, followed by extraction and derivatization of the urinary compounds to their trimethylsilyl ethers and subsequent gas chromatographic-mass fragmentographic detection. To evaluate the assay, aliquots of a urine sample of a healthy individual were analysed in multiplicate; a mean tetrahydroaldosterone concentration of 103 nmol/l and a within-sample, within-day- and day-to-day coefficient of variation of 1.8, 3.2 and 3.4%, respectively, were found. Determination of aldosterone in the same sample yielded a mean concentration of 25.3 nmol/l and the following coefficients of variation: 2.8% (within-sample), 3.8% (within-day) and 4.3% (day-to-day). The urinary excretion of tetrahydroaldosterone and aldosterone in 24-h urine portions was determined in twenty healthy individuals, aged 23-77 years; for tetrahydroaldosterone and aldosterone, an excretion of 94 +/- 66 nmol per 24 h and of 40 +/- 22 nmol per 24 h was found, respectively, in accord with the literature. An example of the usefulness of the described assay is given by establishing the cause of severe salt-wasting in an infant; a highly elevated tetrahydroaldosterone and aldosterone excretion was demonstrated, proving that the child suffered from unresponsiveness to aldosterone (pseudohypoaldosteronism).

Adult↗
PubMed1986

Kinetic measurement of the urinary production rate of cortisol in male piglets: is the prerequisite 'collection until all label has disappeared' necessary?

Urinary cortisol production rate (CPR) was calculated by two different methods in five male piglets (about 3 kg bodyweight) injected i.v. with 40-120 kBq tritiated cortisol ([3H]F. After administration of [3H]F, urine was obtained from four consecutive collections for the following 2 days, during which 80-100% of the label was recovered. Total radioactivity in the urine was measured and used to calculate the total rate constant of 0.115 +/- 0.011 h-1 and, from this, the mean biological half-life (t1/2) of 6.0 +/- 0.6 h (S.D.; n = 4). It was found that the mass ratio of the two principal urinary cortisol metabolites tetrahydrocortisone (THE) and tetrahydrocortisol (THF) was strikingly less than 1.0 (0.4 +/- 0.1; n = 14), which is the reverse of that observed in older pigs, neonatal infants and man. To calculate CPR conventionally, the cumulative specific activities of THE and THF were calculated for the 2-day period of urine collection. The apparent mean CPR values on the basis of THE and THF were calculated as 11.5 +/- 1.6 (n = 5) and 12.8 +/- 3.3 (n = 5) mumol/day respectively, and 12.1 +/- 1.4 (n = 5) mumol/day for the average of THE and THF. The second method for calculating CPR consisted of determining the masses of THE and THF (mumol) per fraction of dose (m/fd) (fd refers to the ratio of radioactivity in the metabolite and dose) at different times after administration of [3H]F. The calculated m/fd values, which are synonymous with the dose divided by the specific activities of the metabolites, and the different times of urine collection were analysed by linear regression. The resulting slope is equal to the CPR. The CPR derived by this method for the average of THE and THF, 10.1 +/- 0.91 mumol/day was significantly (P less than 0.014) lower than that derived conventionally, 12.1 +/- 1.40 mumol/day. This second method may be used when CPR is determined in neonatal infants by means of nonradioactive, deuterated or 13C-enriched cortisol, where the extent of negative feedback by the relatively high dose of exogenous steroid on cortisol secretion must be kept as low as possible. This method also allows urine collections to be used at times when the tracer is still being excreted.

Animals↗
PubMed1985

Smoothing techniques for obtaining reference values for measurements of children.

Constructing reference values for measurements of children, e.g. the mean height as function of age, one needs a smoothing technique. Various techniques will be discussed and applied to a particular study of anthropometric growth. The overall conclusion is that reliable curves can be obtained by using computer programs based on approximations by cubic splines, and by using the eye for choosing from the corresponding outputs.

Adolescent↗
PubMed1984

Incidence of childhood diabetes in The Netherlands: a decrease from north to south over north-western Europe?

The incidence of childhood diabetes (0-19 years of age) in The Netherlands, where there is no nationalized health-care system, was investigated retrospectively in the years 1978 to 1980 inclusive. The method chosen was a questionnaire among all Dutch paediatricians and internal physicians acting as consultants. Ascertainment was by the same questionnaire held separately among the large Dutch membership of the Dutch Diabetes Association, employing the capture-recapture census method for calculation. For paediatricians the ascertainment was 94%, for specialists in internal medicine 75%. Before correction for ascertainment 1271 children were registered in the two surveys. The ascertainment-corrected annual incidence was 10.95/100000 for 0-19-year-old children, lower than in any other ascertained survey in north-western Europe published so far. The male:female ratio was the same as in other studies and no local geographical differences were found. Seasonal variation was absent in children 0-10 years old in the month the first insulin injection was administered. The data support the influence of unknown exogenous factors associated with the clinical onset of childhood diabetes.

Adolescent↗
PubMed1984

[1,2,3,4-13C] testosterone and [1,2,3,4-13C] estradiol.

The preparation of [1,2,3,4-13C] testosterone and of [1,2,3,4-13C] estradiol by total synthesis is described. The 13C labels are introduced by alkylating intermediate 1 with [1,2,3,4-13C]l-iodo-3,3-ethylenedioxybutane (2) to obtain intermediate 10. Hydrolysis of the ketal function, cyclization, aromatization and removal of protective groups gave [1,2,3,4-13C] estradiol. Labeled testosterone was prepared by methylating intermediate 10 and by subsequent treatment with acid. The labeled steroids can be used as tracers for in vivo metabolic studies and as internal standards for the development of definitive gc-ms quantitative methods.

Carbon Isotopes↗
PubMed1984

The synthesis of [1,2,3,4-13C] cortisol.

The preparation of [1,2,3,4-13C] cortisol 21 acetate by total synthesis is described. The C labels are introduced in a way analogous to the one described by us previously for the synthesis of testosterone and estradiol. The cortisol dihydroxyacetone side chain was elaborated using known methods. The 11 beta-hydroxyl function was introduced by addition of hypobromous acid to a 9-double bond followed by reductive debromination. 13C-labeled cortisol can be used as a tracer for the determination of cortisol production rates.

Carbon Isotopes↗