The incidence of hyperthyroidism in Austria from 1987 to 1995 before and after an increase in salt iodization in 1990.

Between 1963 and 1990, Austria had iodized salt prophylaxis of endemic goitre with 10 mg KI (7.5 mg I) per kg. This was obviously insufficient, as urinary iodine excretion ranged from 42 to 78 microg I per g of creatinine and goitre in adults remained in the endemic range of 15%-30%. Therefore salt iodization was doubled in 1990. The aim of this study was to assess the annual incidence of different types of hyperthyroidism (HT) before and after this increase in salt iodization. The incidence of HT was recorded in 14 nuclear medicine centres from 1987 to 1995. In five additional centres data were available from 1992 onwards. Data prior to 1992 were documented retrospectively, while those after 1992 were recorded prospectively. The 14 centres drew patients from an area with a population of approximately 4.23 million while all 19 institutes were estimated to cover an area with a population of 5.4 million (the total population of Austria is 7.86 million). A total of 414232 persons were examined for the first time in the participating centres. HT and the type of HT were defined by clinical examination, serum TSH, thyroid hormone levels in blood, ultrasonography, scintigraphy and serum autoantibody titres. HT was classified into immunogenic HT (Graves' or Basedow's disease, GD) and HT with intrinsic thyroid autonomy (uni-, multinodular or disseminated Plummers' disease, PD). HT was also divided into overt (o) or subclinical (sc) disease. The following data were calculated: annual incidence per 100000 and the relative risk (RR) for HT with 95% confidence intervals (CI). In addition, linear trends were calculated for each type of HT by means of logistic regressions. In the 19 centres a total of 47834 patients with HT were registered from 1987 to 1995. PD accounted for 75% of all cases of HT and GD for 19%, while other types of HT were present in 6%. From 1987 to 1989 (time period T0), the annual incidence of oPD was 30.5 (95% CI 29.6-31.5) per 100000. The RR compared to the baseline period T0 was highest in 1992 (1.37; 1.3-1.45) and decreased to 1.17 (1.1-1.24) in 1995. The annual incidence of scPD in T0 was 27.4 (26.5-28.3) per 100000. The RR was highest in 1991 (1.64; 1.56-1.73) and was 1.60 (1. 51-1.69) in 1995. In oPD and scPD a higher RR was observed in persons older than 50 years of age, particularly in men. The incidence of oGD in T0 was 10.4 (9.8-10.9) per 100000; the maximum RR increased to 2.19 (2.01-2.38) in 1993 and decreased to 1.95 (1.78-2.13) in 1995. The incidence of scGD was 1.9 (1.6-2.1) in T0. The maximum RR was observed in 1994 (2.47; 2.04-3.0) and it was still 2.26 (1.85-2.77) in 1995. The increased incidence of oGD and scGD was evenly distributed in all ages and both sexes. The time course of different types of HT following the increase in salt iodization could be divided into two phases: an increase in the incidences of HT with peaks after 1-4 years and a subsequent decrease, the only exception being scGD. The effect was more pronounced in GD than in PD. PD showed an age and gender dependency over time, while GD did not.

[Scintigraphic monitoring of chondro-protective therapy of finger polyarthritis]. / Szintigraphische Kontrolle einer chondroprotektiven Therapie von Fingerpolyarthrosen.

A pilot study in patients with osteoarthritis of fingers was done to clarify the question, whether abnormal joints in bone scanning can predict degenerative changes in X-rays and if scintigraphy is of help in monitoring therapy with chondroprotective medications. 2 groups of 7 patients with symptomatic osteoarthritis of fingers were treated either with galvanic bath alone or in combination with Rumalon-injections for 6 weeks. After therapy the number of abnormal joints in bone scan and number of tender joints was found reduced in both groups, a decrease of the mean circumference of joints was only seen in the Rumalon-group. After 1 year an increase of degenerative signs in X-rays was demonstrated in both groups. But the number of tender joints was smaller in the Rumalon-group than in controls. For abnormal joints in bone scanning a high positive value was calculated regarding to signs of osteoarthritis in radiographs. But no major information in monitoring the chondroprotective efficacy of the medicament was given by bone scanning.

[Hepatitis B antigen in patients undergoing gastroscopy (author's transl)]. / Hepatitis-B-Marker bei Gastroskopiepatienten.

497 patients undergoing gastroscopy were tested for RIA for HBs antigen, HBs antibody and HBc antibody. In 21.9% of these patients (women 19.6%, men 23.3%) one of these tests was positive. The high frequency of positive HBc antibody is remarkable. 7% of our patients (women 7.8%, men 6.3%) were HBs antigen positive and, therefore, a source of infection for doctors and nurses of an endoscopic unit. The results are comparable with studies from other units reported in the literature.

[Clinical and morphological features during the course of Whipple's disease(author's transl)]. / Klinische und morphologische Verlaufsbeobachtung der Lipodystrophia intestinalis (M. Whipple)

Clinical and histological characteristics of Whipple's disease have been described extensively by various authors, but there are only few reports about repeated documentation of clinical and especially of micromorphological features during the course of the disease. We therefore report a case who was followed closely over a period of 3 years; small bowel biopsy was performed on 6 occasions during this time. Antibiotic therapy brought complete recovery from the disease and was followed by the disappearance of bacillary bodies in the lamina propria of intestinal mucosa. Despite this, many macrophages containing the typical PAS-positive material could still be demonstrated. The development of macrophages as well as etiologic aspects of the disease are discussed.

[Liver scanning in diffuse liver disease (author's transl)]. / Leberszintigraphie bei diffusen Leberparenchymerkrankungen

The results of liver scans performed with 99mTc-sulphur colloid in 169 patients suffering from diffuse liver diseases and in 48 normal controls were evaluated. The patients with reactive hepatitis, acute hepatitis, chronic persistent hepatitis, fatty liver and fibrosis of the liver show only minimal deviations from the scintigraphic pattern. On the contrary, highly increased colloid uptake in the spleen is found in cases of chronic aggressive hepatitis, whilst the intrahepatic distribution of the colloid is approximately normal. In cases of liver cirrhosis, increased colloid uptake is found in the left lobe of the liver as well as in the spleen and in the bone marrow. Either normal findings or cirrhosis-like changes of the colloid distribution are observed in patients with alcoholic hepatitis.