Comparative analytical evaluation of thyroid hormone levels in pregnancy and in women taking oral contraceptives: a study from an iodine deficient area.

Increase of serum thyroxine binding globulin (TBG) resulting from estrogen action may lead to problems in thyroid diagnostics. The aim of the present study was to define the most diagnostically reliable thyroid parameters in women exposed to differentially elevated estrogens. Sera of three groups of healthy women were analyzed: women taking no medicine (controls), those taking oral contraceptives and pregnant women (in weeks 16 or 32 of gestation). All women involved in the study lived in a moderately iodine-deficient geographical area. Thyroid stimulating hormone (TSH), TBG, total thyroxine (T4), total tri-iodothyronine (T3) and free T3 were determined and free T4 indices (total T4 x T3 uptake; total T4/thyroxine binding capacity (TBC); total T4/TBG) were calculated. Free T4 was measured simultaneously with a one-step T4-analog enzyme-linked immunosorbent assay (ELISA), a labeled T4 antibody radioimmunoassay (RIA), and a two-step microparticle enzyme immunoassay (MEIA). Estrogen-dependent differences were found in all investigated parameters; however, they remained in the reference interval for TSH, total T4 x T3 uptake, total T4/TBC,free T3 and free T4 MEIA. It was concluded that simultaneous estimations of free T4 and free T3 should follow a primary TSH measurement. The necessity of a distinct reference range has emerged for free thyroid hormones in midterm and late pregnancy as well as in the use of oral contraceptives, especially in iodine-deficient areas.

[Percutaneous sclerotherapy of thyroid cysts]. / A pajzsmirigycysták percutan sclerotisatiója.

The authors have performed percutaneous ethanol sclerotherapy in 9 patients suffering from thyroid cysts causing physical and cosmetic complaints during the last 4 years. All cysts proved to be benign by US and aspiration cytology. The sclerotherapy resulted in definitive recovery in 8 cases. No complications of the procedure were noticed.

[Diagnostic value of thyroid antibodies]. / A pajzsmirigy elleni autoantitestek diagnosztikus értéke.

Thyroid antibodies against thyroglobulin, the microsomal fraction and TSH receptor have been investigated in 150 patients (41 of them with Graves'disease, 24 of them with Hashimoto thyroiditis, 21 of them with subacute thyroiditis and 34 cases with treated hypothyroidism). 30 patients having thyroid disease without immune etiology served as a control group. As compared with the control group, significant differences were detected in the titers of microsomal and TSH-receptor antibodies in Graves' disease, microsomal and thyroglobulin antibodies in Hashimoto thyroiditis, while significantly higher antibody titers were measured against the microsomal fraction antibodies in hypothyroidism. In subacute thyroiditis, no significant elevation of any of the three antibodies was demonstrated. The diagnostic values of antibodies were investigated; in Graves disease, the antibody against TSH receptor is the most sensitivity method (70%), while in Hashimoto thyroiditis the highest sensitivity (87,5%) is exhibited by the determination antibody against the microsomal fraction. The relationship between the thyroid hormone values and the antibody titer was investigated too. In Hashimoto thyroiditis with hypothyroid state significantly elevated microsomal antibodies were found, as compared with the euthyroid state. It may be concluded that in cases suspect of Graves disease, determination of antibody against of TSH receptor is recommended. In case of normal value, finding the antibody against microsomal fraction can confirm the diagnosis. In further conclusion, antibody measurements are rarely informative in subacute thyroiditis. In cases suspect of other thyroid diseases of immune origin, measurement of the antibodies against the microsomal fraction may be helpful, while the discriminative value of the thyroglobulin antibody is more limited.

[Effect of interferon-alpha2b therapy in chronic hepatitis C]. / Interferon-alpha 2B kezelés hatása chronicus C hepatitisben.

In chronic hepatitis C the interferon treatment given three times a week in a dosage of 3 million units (MU) normalizes the values of alanin-amino-transferase in a part of cases (25-40%), and produces bettering in the subjective complains of patients. In the short term therapy (3-6 months) the activity of ALT increases again after leaving the therapy, and the disease becomes active. The aim of this multicenter study in Hungary was to give newer data in the case of longterm efficacy with alpha-interferon. Ninety-one patients with chronic hepatitis C were selected into the open prospective clinical study in university and hospital departments. Treatment protocol was the following: Patients with chronic hepatitis C diagnosed by clinical and histological methods were treated with interferon-alpha 2B given 3 times a week in a dosage of 3 MU. Treatment period had lasted for one year and afterwards the patient had been on control for an other half a year. In non responder cases after 3 month treatment with interferon the dose of therapy was increased for 3 x 5 MU. In 37 cases (40.6%) out of 91 patients the authors found longterm sustained remission and in other 22 cases (24.2%) they observed a partial remission (among them 5 cases with late relapse). The rate of longterm sustained remission under 40 years was higher, than above 40. Higher rate was found when the treatment was started with a shorter chronicity of the disease. On te basis of the results the authors conclude: Interferon-alpha 2B is a good therapeutic modality for the treatment of patients with chronic hepatitis C. Efficacy of therapy is higher in younger patients and also in earlier application.

[Clinical significance of the ultrasensitive TSH assay]. / A TSH ultrasensitiv-assay alkalmazásának klinikai jelentösége.

The authors attempted to answer the question whether the low thyroid stimulating hormone (TSH) levels measurable by the TSH ultrasensitive DELFIA kit have any clinical significance and whether they are more informative than the results obtained by the supersensitive TSH assay. No measurable TSH was detected in 111 sera among 896 random specimens, by using a supersensitive fluorimetric kit. These 111 sera were further investigated, TSH was measured by an ultrasensitive assay, in addition, the levels of the peripheral hormones (total T4, total T3, T3-uptake, free T4, free T3), were also determined. On basis of the latter, the patients were classified as having subclinical (n = 28) or manifest (n = 80) hyperthyroidism. The TSH levels of the patients affected by manifest hyperthyroidism were found significantly (p < 0.0001) lower than those encountered in subclinical hyperthyroidism. The groups were then further divided to homogeneous clinical subgroups (patients treated with thyrostatic drugs, untreated patients, toxic adenoma, Graves' disease) and the results were analyzed. It can be stated that the ultrasensitive test safely distinguishes manifest and subclinical disease in all subgroups (range of sensitivity: 90.0-94.7%). Specificity for the diagnosis of subclinical hyperthyroidism was 66.7% for the untreated subgroups, irrespective of aetiology, while in treated patients the value of specificity was 10%. In Graves' disease, specificity was 100%, in toxic adenoma 0% (the number of patients, however, was very small in these homogeneous subgroups). These results suggest that although the ultrasensitive method furnishes more information than the supersensitive test, its exclusive application would not be appropriate in characterizing thyroid function because of the broad range of individual scatter.

[Hepatitis B and C markers in alcoholic liver diseases]. / Hepatitis B- és C-vírus marker vizsgálatok alkohol okozta májbetegségekben.

Hepatitis B and C virus contamination of 240 patients with alcoholic liver disease was studied. Hepatitis B virus core antibodies were present in 58 alcoholic patients (24%) and hepatitis C virus antibodies in 30 alcoholic patients (12.5%). Both antibodies were present in 17 patients (7.1%). The prevalence of antibodies was more frequent in alcoholic female patients than in males. Data concerning the hepatitis B virus contamination in alcoholic liver patients with or without cirrhosis were similar. The frequency of hepatitis C virus antibodies in cirrhotic patients was more than in patients without cirrhosis. Female cirrhotic patients were more frequently C virus antibody positive than males. In female alcoholics the frequency of C virus antibodies was more in patients with cirrhosis than in the patients without cirrhosis. The viral serology and follow up of patients with alcoholic liver disease may be useful in detection of the early stage hepatocellular carcinoma.

[New strategy for thyroid function testing]. / Uj stratégia a pajzsmirigyfunkció diagnosztikájában.

The authors used a new protocol, based upon a supersensitive TSH assay, to examine the thyroid status of 1720 patients. Based upon the serum hormone levels, the patients were divided into different clinical groups. The biochemical relationship between the different hormone levels, and the rate of occurrence of various thyroid diseases were studied. 76.1% of the new patients hadn't received any previous treatment. 15.5% of those patients who had received treatment had hyperthyroidism, while 8.4% of those had hypothyroidism. 76% of the new patients, 38.3% of those who had hyperthyroidism, and only 29.7% of those who had hypothyroidism, were euthyroid. Undetectable TSH levels (< 0.03 mU/L) where observed in 51.8% of the new hyperthyroid patients, and in 33.8% of those who had subclinical hyperthyroidism. Similar results were obtained with those who had been previously treated for hyperthyroidism. The new protocol has the following advantages: it's more convenient to the patients, it's quick, it's economical. With this method it is possible to reduce the assays per patient by 31%. The algorithm was supplemented with results of free hormone levels. By doing this the authors were able to measure free-T4 and T3 hormone levels of 150 more patients. According to the authors, the free-T4 test is more informative than the free-T4-index, especially in the border-line cases and in treated hyperthyroidism. Primarily the free-T3 test is most necessary when examining patients treated with methimasol.

[Helicobacter pylori allergy]. / Helicobacter pylori allergia.

A case of a 44 year old woman with antrum gastritis and H. pylori infection was reported. After unsuccessful treatment of the disorder with bismuth and tinidazole, an auto-vaccine was prepared from the bacterium in order to eliminate the infection. After the first injection of the vaccine a generalised urticaria was observed. In the development of the skin eruptions a type I, and a type IV allergic reaction could be demonstrated using the H. pylori specific RAST-test and leukocyte migration inhibition respectively. After eradication of the bacterium by amoxycillin treatment, the clinical signs of both the gastrointestinal and allergic diseases disappeared.

[Does Campylobacter Helicobacter pylori infection have a clinical relevance? Methodologic, epidemiologic and clinical studies]. / Hat die Campylobacter Helicobacter pylori Infektion eine klinische Relevanz? Methodologische, epidemiologische und klinische Untersuchungen.

The authors searched for Campylobacter pylori (CP) in gastric biopsies from 180 patients by means of microbiological culture. Warthin-Starry staining and urease activity determination. 50 patients with CP-positive antral gastritis were treated with bismuthsubsalicylate 2.4 g per day for 3 weeks, followed by a therapy-free interval of 7-10 days and then a control biopsy was performed. Combined results of bacterial culture and histology proved to be mostly reliable. The prevalence of CP in Hungary is similar to other European countries. CP-positivity was found at the following rates: endoscopically normal patients 30%; stump gastritis 30%; antral gastritis 75%; duodenal ulcer 89%. In all CP-positive cases chronic antral gastritis was seen, whereas normal antral mucosa was never CP-positive. There was no correlation between dyspeptic complaints and CP-positive chronic antral gastritis. Both decreased after bismuth therapy independently on the elimination of CP. CP-positivity in 2/3 of the control investigations points to fast recolonization. The clinical relevance of the CP-infection seems to be questionable.

[Has Campylobacter pylori infection any clinical relevance? Methodologic, epidemiologic and clinical studies]. / Van-e klinikai relevanciája a Campylobacter pylori infekciónak? Metodikai, epidemiológiai és klinikai vizsgálatok.

The occurrence of Campylobacter pylori (CP) was studied in 180 patients referred for endoscopy. The bacterium was detected by culture, histology (Warthin-Starry staining) and urease test of antral biopsy samples. Patient groups were formed according to endoscopic diagnoses, clinical symptoms and antral mucosal histology. 50 CP positive patients with chronic antral gastritis were treated by bismuth subsalicylate (2,4 g/day) for 3 weeks. Positivity by culture and/or silver-stained histology proved to be the most reliable way for detecting CP. CP was proved in about 30% in patients with normal gastroduodenum (13/42) or with stump gastritis (4/15), in 75% with endoscopic antral gastritis (51/68) and in 89% with duodenal ulcer (49/55). A close relationship between CP and histological chronic antral gastritis could be demonstrated. No causal link between CP positive chronic active antral gastritis and non-ulcer dyspepsia could be verified. The decrease in histological activity of chronic gastritis and in dyspeptic complaints after bismuth salt therapy was found to be independent of CP elimination. The results of control investigations following a therapy-free interval of 7-10 days speak in favour of CP recolonialisation within a relativelly short period. It can be concluded that, despite the undeniable relationship between CP and chronic antral gastritis and duodenal ulcer, further studies are necessary to clarify the clinical relevance of the CP infection.

[Onset of Philadelphia chromosome negative chronic myeloid leukemia with symptoms of intrahepatic cholestasis]. / Intrahepatikus cholostasis tüneteivel kezdödö Philadelphia chromosoma negatív chronikus myeloid leukaemia.

The case of a chronic myelogenous leukemia (CML) starting in an unusual form in a young woman is reported. Rapidly progressing icterus was the first and leading symptom of the disease. Simultaneously with the exclusion of the possibility of hepatitis and extrahepatic obstruction of the bile duct the qualitative blood picture roused the suspicion of a myeloproliferative disease. Detailed hematological examinations confirmed Philadelphia chromosome (Ph1) negative CML. Besides the histologically diffuse leukemic infiltration intrahepatic cholostasis could be demonstrated in the background of the icterus. In the chronic and accelerated phase clinical symptoms developing as a consequence of hepatic organic manifestation were dominating. In the authors's case the moderate leukocytosis, initial thrombocytopenia, absence of splenomegaly, early blast-phase and short survival were atypical, characteristic of Ph1 negative CML. The diagnosis and the absence of other associated hepatopathies was supported also by the post-mortem examination. CML beginning with icteric symptoms due to intrahepatic cholostasis is considered as rarity in the literature.