Current status of iodine deficiency-related disorders prophylaxis in Slovakia - the life's work of Julian Podoba remained unfinished.

OBJECTIVE: Prophylaxis of iodine deficiency-related disorders with iodized salt in Slovakia was introduced in 1951. This prophylactic measure yielded remarkably good results. Endemic goiter and endemic cretinism disappeared. Sufficient iodine intake, mainly in children and adolescents, was confirmed in several local and international studies carried out in the period 1991-95. Unfortunately, since seventies, there has been no institution which would have dealt with iodine prophylaxis in such an extent as this important measure of Slovak preventive medicine would require. Neither systematic monitoring of iodine intake nor systematic population epidemiological studies have been carried out. We do not have any data on the iodine intake in pregnant women, the most vulnerable population group in relation to the iodine deficiency. During the period June 2014 - October 2015, we examined iodine excretion in 426 probands from three regions of Slovakia with an emphasis on the pregnant women. RESULTS: Iodine intake was found to be sufficient, even more than adequate, in all age groups of Slovak population. The only population group with iodine intake borderline or very mild iodine deficiency are pregnant women. CONCLUSIONS: 1/ Iodine nutrition in Slovakia is generally sufficient, even oversteps the requirement, with the exception of pregnant women. Iodine intake in pregnant women should be fortified by iodine containing multivitamin preparations. 2/ We recommend to include the examination of urinary iodine into the screening of thyropathies in early pregnancy. 3/ It is not enough to implement the iodine deficiency-related disorders prevention programs, it is also necessary to stabilize such programs over time and balance the benefits with possible side effects of this program.

MR imaging of late radiation therapy- and chemotherapy-induced injury: a pictorial essay.

Radiation to the brain and adjuvant chemotherapy may produce late delayed changes from several months to years after treatment of intracranial malignancies with a reported prevalence of 5-24%. The pattern of treatment-related injury may vary from diffuse periventricular white matter lesions to focal or multifocal lesions. Differentiation of treatment-related injury from tumor progression/recurrence may be difficult with conventional MR imaging (MRI). With both disease processes, the characteristic but nonspecific imaging features are vasogenic edema, contrast enhancement, and mass effect. This pictorial essay presents MRI spectra of late therapy-induced injuries in the brain with a particular emphasis on radiation necrosis, the most common and severe form. Novel MRI techniques, such as diffusion-weighted imaging (DWI), proton MR spectroscopy (MRS), and perfusion MRI, improve the possibilities of better characterization of treatment-related changes. Advanced MRI techniques allow for the assessment of metabolism and physiology and may increase specificity for therapy-induced changes.

A survey of iodine intake and thyroid volume in Dutch schoolchildren: reference values in an iodine-sufficient area and the effect of puberty.

BACKGROUND: Iodine deficiency and endemic goiter have been reported in the past in The Netherlands, especially in the southeast. OBJECTIVE: To evaluate iodine intake and thyroid size in Dutch schoolchildren, contrasting those living in a formerly iodine-deficient region in the east (Doetinchem) with those living in an iodine-sufficient region in the west (Amsterdam area). DESIGN: Cross-sectional survey of 937 Dutch schoolchildren aged 6--18 years, of whom 390 lived in the eastern and 547 in the western part of the country. METHODS: Thyroid size was assessed by inspection and palpation as well as by ultrasound. Iodine intake was evaluated by questionnaires on dietary habits and by measurement of urinary iodine concentration. RESULTS: Eastern and western regions were similar with respect to median urinary iodine concentration (15.7 and 15.3 microg/dl, NS, Mann-Whitney U test), goiter prevalence by inspection and palpation (0.8 and 2.6%, P=0.08, chi-squared test), and thyroid volumes. The P97.5 values of thyroid volumes per age and body surface area group were all lower than the corresponding sex-specific normative WHO reference values. Iodized salt was not used by 45.7% of households. Daily bread consumption was five slices by boys and four slices by girls. Weekly milk consumption was 3 liters by boys and 2 liters by girls. Seafish was consumed once monthly. From these figures we calculated a mean daily iodine intake of 171 microg in boys and 143 microg in girls, in good agreement with the measured median urinary concentration of 16.7 microg/dl in boys and 14.5 microg/dl in girls. The sex difference in iodine excretion is fully accounted for by an extra daily consumption of one slice of bread (20 microg I) and one-seventh of a liter of milk (8.3 microg I) by boys. Thyroid volume increases with age, but a steep increase by 41% was observed in girls between 11 and 12 years, and by 55% in boys between 13 and 14 years, coinciding with peak height velocity. Girls have a larger thyroid volume at the ages of 12 and 13 years, but thyroid volume is larger in boys as of the age of 14 years. CONCLUSIONS: (1) Iodine deficiency disorders no longer exist in The Netherlands. (2) Bread consumption remains the main source of dietary iodine in The Netherlands; the contribution of iodized table salt and seafish is limited. (3) The earlier onset of puberty in girls renders their thyroid volume larger than in boys at the age of 12--13 years, but boys have a larger thyroid volume as of the age of 14 years.

Thyroid volumes and urinary iodine in Swiss school children, 17 years after improved prophylaxis of iodine deficiency.

Salt iodine content in Switzerland was raised from 7.5 to 15 mg per kg in 1980, and since then dietary iodine intake has been considered to be sufficient, even though a slight decrease due to imported food has recently been reported. The aim of this study was to establish normal values for thyroid volumes of school children who can be assumed to have had a sufficient iodine intake all their lifetime. Moreover. the present investigation was undertaken to verify that iodine sufficiency had been achieved equally in two regions each served by one of the two Swiss salt producers. Mean iodine concentration in urine spot samples from school children was 16.1 microg/dl, and it was identical in both the city of Lausanne (n=215) and the city of Solothurn (n=208). Thus it can be stated that in both cities (served by two different salt producers) iodine intake is equal and sufficient. Accordingly, thyroid volumes measured by ultrasound in school children aged 6 to 16 years were the same in both Lausanne (n=202) and Solothurn (n=207). Moreover, the age-adjusted median volumes at the 97th percentiles closely agree with and validate provisional international reference values recently proposed by the World Health Organisation and by the International Council for Control of Iodine Deficiency Disease.

[The effectiveness of iodine prophylaxis of endemic goiter in Slovakia from the viewpoint of physical and ultrasonographic examinations of the thyroid gland]. / Ucinnost jódovej profylaxie endemickej strumy na Slovensku z hl'adiska fyzikálneho a ultrasonografického vysetrenia stítnej zl'azy.

Being aimed at the effectivity of iodine prophylaxis of endemic goitre the authors examined 2946 children and adolescents at the age of 6-18 years during the period from 1989 to 1995 in 6 regions of Slovakia. The thyroid glands were examined physically and ultrasonographically. The authors have found out that the occurrence rate of diffuse goitre is acceptable and it is not meeting the criteria of endemic goitre. No case of nodular goitre was revealed. Similarly to the relative frequency of diffuse goitre, neither the ultrasonographically measured volumes of thyroid glands differed among various areas. They are comparable with the volumes detected in countries with a sufficient iodine supply. The use of criteria for iodine deficiency evaluation recommended by WHO (goitre occurrence, thyroid gland volume, ioduria) leads the authors to consider the current prophylaxis of endemic goitre as being effective and successful. (Tab. 5, Ref. 20.).

[Comparison of the glomerular filtration rate using renal plasma clearance of 51Cr-EDTA and biochemical methods]. / Porovnanie glomerulárnej filtrácie stanovenej renálnym plazmatickým clearance 51Cr-EDTA a biochemickými metódami.

In 22 patients (age 19 to 73 years) the authors examined the glomerular filtration by assessing the renal clearance of 51Cr-EDTA in addition to the plasmatic method with several blood samples, methods with a smaller number of blood samples and external assessment of the radioactivity, or else by estimation of the creatinine clearance by biochemical methods. They used as the reference method assessment of the renal plasma clearance of 51Cr-EDTA by means of a one-compartment model from the radioactivity of blood samples collected during the 60th, 120th and 180th minute. It was revealed that for the normal value of glomerular filtration (GF = 1.8 ml/s) and for its reduced value (GF = 0.5 ml/s), as compared with the reference method RP, the highest external and internal accuracy, i.e. the best agreement with the reference method and the closest interval estimates, are obtained by the single sample method RE (blood sample during the 120th minute), supplemented by three external assessments of radioactivity during the 50th-70th, 110th-130th and 170th-190th minute. The regression relationship of these methods is expressed by the following equations: RE = -8.9 + 1.06 . RP; RP = 8.47 + 0.94 . RE. The biochemical methods were, as compared with the radionuclide ones, less accurate. Their accuracy declined in the order from the calculated creatinine clearance according to Cockcroft and Gault via the inverse value of the serum creatinine concentration towards the 24-hour creatinine clearance.

Acute haemodynamic effect of metoprolol in essential hypertension.

The acute haemodynamic effect of metoprolol was investigated in 14 patients with essential hypertension (7 of the WHO stage I, 7 of stage II). The evaluated parameters include the mean arterial blood pressure (MBP), heart rate (HR), cardiac index (CI), total peripheral resistance (TPR) and capillary blood flow of the forearm muscle (CBF). Investigation was carried out within two days: the 1st day at rest and after an infusion of 20% mannitol, the 2nd day with additional previous intravenous administration of 5 mg of metoprolol. The findings were as follows: 1. There was a decrease of MBP, a slowdown of HR and a decrease of CBF after metoprolol both in hypertensives I and II. 2. The different haemodynamic response of the Ist and IInd stages of essential hypertension was manifested by a significant decrease of CI and an increase of TPR in hypertensives II (but not I) not only after the infusion of mannitol alone, but also after i.v. administration of metoprolol. The exaggerated haemodynamic response to acute metoprolol administration in essential hypertension II could be caused by latently impaired cardiac performance in this stage.