Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years.

BACKGROUND: Patients with coeliac disease are advised to keep to a lifelong gluten-free diet to remain well. Uncertainty still exists as to whether this gives a nutritionally balanced diet. AIM: To assess the vitamin nutrition status of a series of coeliac patients living on a gluten-free diet for 10 years. METHODS: Thirty adults with coeliac disease (mean age, 55 years; range, 45-64 years; 60% women), in biopsy-proven remission following 8-12 years of dietary treatment, were studied. We measured the total plasma homocysteine level, a metabolic marker of folate, vitamin B-6 and vitamin B-12 deficiency, and related plasma vitamin levels. The daily vitamin intake level was assessed using a 4-day food record. Normative data were obtained from the general population of the same age. RESULTS: Coeliac patients showed a higher total plasma homocysteine level than the general population, indicative of a poor vitamin status. In accordance, the plasma levels of folate and pyridoxal 5'-phosphate (active form of vitamin B-6) were low in 37% and 20%, respectively, and accounted for 33% of the variation of the total plasma homocysteine level (P < 0.008). The mean daily intakes of folate and vitamin B-12, but not of vitamin B-6, were significantly lower in coeliac patients than in controls. CONCLUSIONS: Half of the adult coeliac patients carefully treated with a gluten-free diet for several years showed signs of a poor vitamin status. This may have clinical implications considering the linkage between vitamin deficiency, elevated total plasma homocysteine levels and cardiovascular disease. The results may suggest that, when following up adults with coeliac disease, the vitamin status should be reviewed.

[Lateral urethrocystography in digital subtraction technique]. / Die laterale Urethrozystographie in digitaler Subtraktionstechnik.

The first application of the digital subtraction technique to lateral urethrocystography is described. This methodology facilitates gynecological-urological operations by providing reliable investigation results and an unambiguous image interpretation. Methods and first experiences with the digital subtraction technique in gynecological-urological diagnosis are reported.

[Color-coded duplex ultrasonography compared to phlebography in deep leg and pelvic vein thrombosis]. / Farbkodierte Duplex-Sonographie im Vergleich zur Phlebographie bei tiefer Bein- und Beckenvenenthrombose.

Between March 1990 and March 1991, in a prospective study, 100 patients (53 men, 47 women, median age 61.5 years) with suspected deep venous thrombosis of the lower extremities, colour duplex ultrasonography (CDU) (Ultramark 9, ATL) were investigated using the slow-flow technique. The CDU findings obtained for the external iliac vein (distal segment), the common femoral, the superficial femoral and popliteal veins, together with those of the veins of the lower extremity, were compared with the results of phlebography, which is considered to be the gold standard for this type of investigation. The sensitivity/specificity of CDU in diagnosing deep venous thrombosis was, from proximal to distal: 95.4%/100%, 100%/99%, 96.8%/97.1%, 98.5%/95.5% and 96.3%/98%. Fibrinolytic therapy (ultra high-dose short-term therapy: n = 16 patients; conventional fibrinolytic therapy: n = 4 patients) was indicated in 20 patients. In this group of patients identical results were obtained with CDU and ascending phlebography. Our experience shows CDU to be a supplementary diagnostic procedure to real-time B mode ultrasonic imaging in the establishment of the primary diagnosis, and to be superior to it in the follow-up evaluation of the results of fibrinolytic treatment. Both in the establishment of the primary diagnosis and follow-up of thrombosis of the deep leg and pelvic veins, CDU is the equal of phlebography. The advantage of the latter is in the documentation of the entire venous system and staging of post-thrombotic syndrome.

[Radiation loading problems in petrous bone tomography. Experimental research using film dosimetry on the Alderson phantom]. / Probleme der Strahlenbelastung bei der Felsenbeintomographie. Experimentelle Untersuchung mittels Filmdosimetrie am Alderson-Phantom.

Using film dosimetry and an Alderson skull phantom, the iso-dose distribution during tomography of the petrous bone was investigated. We were particularly concerned with the radiation dose to the lens of the eye, the critical organ in the skull, and to the inner ear, using different types of examination and various positions of the skull. The choice of suitable film material and standardisation against TLD measurements is crucial for the accuracy of film dosimetry, allowing for correction of film blackening in relation to varying energies. Tomography of the petrous bone in the prone position produced a reduction in radiation dose to the eye to only 1 to 4% of the dose incident on the occiput. In this way, and using high definition screen and grinds, it is possible to obtain optimal tomographic images despite drastic reduction of the scattered radiation to the eye. Radiation dose to the inner ear is greatly below any significant somatic does, irrespective of projection or technique. Special measures to reduce radiation to the inner ear are neither effective nor sensible.

[Significance of bone changes in the internal auditory meatus in acoustic tumors and in the "empty" enlarged inner ear canal]. / Die Wertigkeit knöcherner Veränderungen am Meatus acusticus internus bei Akustikustumoren und beim "leeren" erweiterten inneren Gehörgang.

The unilateral extension of shortening of the internal auditory meatus is a very safe bony sign of the presence of a neurinoma of the auditory nerve. Differential diagnosis is necessary to exclude an "empty" extended internal auditory meatus. On the other hand, 31% of the definitely established neurinomas do not show up in the plain tomogram. These facts prove that despite the presence or absence of allegedly definite bony changes at the internal auditory meatus further diagnostic measures are imperative, especially an air meatography in conjunction with high resolution computed tomography.

[High-resolution computed tomography of femur head necrosis]. / Hochauflösende Computertomographie bei der Femurkopfnekrose.

High resolution CT with reconstruction in the sagittal and coronal planes plays a central role in the diagnosis of necrosis of the femoral head. It provides the diagnostician and surgeon with a means for early diagnosis and for determining the extent and localisation of the bone changes; this assists in planning treatment. Additional diagnostic imaging methods are only necessary in isolated cases.

[Digital subtraction angiography as an aid in decision-making in problematic approaches to the superior vena cava]. / Die digitale Subtraktionsangiographie als Entscheidungshilfe bei problematischen Zugängen zur Vena Cava Superior.

By digital subtraction angiography (DSA), diagnostic statements can be made even with low concentrations of contrast medium. Despite the increasing dilution of contrast medium, a definite statement on mediastinal vessel condition is possible in direct visualisation of the arm veins up to the vena cava superior as well as of collaterals using peripheral injection of the contrast medium. Two case histories show that the investigator has definite criteria at his disposal enabling him to forgo frustrating puncture attempts in the area of the vena subclavia, vena jugularis interna and vena anonyma in case of suspected thrombotic vessel closure after long-term parenteral nutrition.

[Spiral tomography with a narrow blurring angle. A valuable supplement to clinical routine]. / Spiraltomographie mit kleinem Verwischungswinkel Eine wertvolle Ergänzung für die klinische Routine.

Narrow-angle tomography with spiral blurring offers for the first time a possibility of combining the advantages of sonography with those of multidimensional tomography. This results not only in an improved image contrast of the tomographs, but also in an image which is largely free from interfering shadows. Hence, it is recommended to employ this method both for organs in the soft parts and, in particular, for exploring specific problems involved in diagnosis of the skeleton.

[Enlarged "empty" internal auditory canal -- its role in differential diagnosis of the acoustic neuroma (author's transl)]. / Der weite innere Gehörgang -- seine Wertigkeit in der Differentialdiagnose des Akustikusneurinoms.

Plain roentgenography of the petrous bone showed in 24 of our otoneurological patients an enlargement of the internal auditory canal. The vertical diameter was more than 8 mm. Otoneurological findings in these patients were mostly the same as found in acoustic neuromas. Exclusion of the presence of a tumor in the internal auditory canal is possible by meatography only. The enlarged "empty" internal auditory canal seems to be a departure from the usual. The incidence of this radiological finding in our patients was 1:83.

[Changes in thyroid function following iodine-containing contrast administration in patients in an endemic goitre area (author's transl)]. / Anderung der Schilddrüsenfunktion nach jodhaltigen Röntgenkontrastmitteln bei Patienten aus einem endemischen Strumagebiet.

A prospective study of thyroid function after the administration of iodine-containing radiographic contrast media was carried out on 119 patients from an area where goitres are endemic. Eighteen patients had a negative TRH test after 28 days. 27.9% of patients after oral cholecystography, 15.1% of patients after intravenous cholangiography and 5.3% of patients after infusion urography, showed hyperthyroid function. In these patients, thyroxin and triiodothyronine levels were higher than in euthyroid patients. Thyroid stimulating antibodies could not be demonstrated. Induction of hyperthyroidism by iodine is considered to be due to autonomy of the thyroid gland parenchyma. For this reason the risk of iodine-induced hyperthyroidism is greater in patients from a goitre endemic region (by a factor of 1.3 to 17.1).

[Unusual abscess formation in the posterior mediastinum (author's transl)]. / Ungewöhnliche Abszessbildung im hinteren Mediastinum.

Pathological processes in the interpleural space appear on x-ray film as space-occupying growths. The assessment of such processes will always require x-ray films of the thoracic organs in two planes, rotating fluoroscopy and spot films as well as tomography. Additional information is obtained via oesophagus contrast radiography, angiography and mediastinoscopy. Computer tomography, being a non-invasive method, has proved very effective in such cases. Formation of an abscess in the mediastinum is rare, since the usually preceding mediastinitis is fatal even before an abscess is formed. In patients from countries where tuberculosis is still frequent, the possibility of formation of a cold abscess via liquafaction of specifically infected lymph nodes must be included in the differential diagnosis of mediastinal enlargement.

[Indications for the computer tomographic investigation of the suprarenal gland (author's transl)]. / Indikationen zur computertomographischen Nebennierenuntersuchung; Leistungsfähigkeit, Stellenwert und Differentialdiagnostik.

The introduction of the third and fourth generation of CT scanners (scan times of 1 to 20 seconds) has brought about a change in the choice of methods for investigating suspected suprarenal disease. The excellent spacial resolution of CT scans permits accurate evaluation of minor changes in the gland. As a result, it is often possible to avoid invasive diagnostic procedures. The typical pathological findings, which can be seen on computer tomograms, are demonstrated and discussed, beginning with the most important abnormalities of the suprarenals. The value of contrast enhancement in various conditions was investigated. Computer tomography is now the most important means of diagnosing suspected suprarenal gland disease, both with regard to specificity and accuracy. Ultrasound is useful as a survey method, whereas angiography is being displaced as a result.

[Iodine-induced hyperthyroidism due to contrast media (author's transl)]. / Jodinduzierte Hyperthyreose durch Konstrastmittel.

A prospective study in an area with endemic goitre showed 18 patients (15.1%) out of 119 investigated with iodine containing contrast media to be hyperthyroid after 28 days. Oral cholecystography led to the highest (27.9%) and infusion urography to the lowest (5.3%) rate of hyperthyroidism. Determination of the serum concentration of thyroxine, triiodothyronine, basal and stimulated thyrotropine is not a suitable method to detect the risk for hormonally euthyroid patients before a contrast media investigation.

[Long-term follow-up after spontaneous contrast extravasation during infusion urograms (author's transl)]. / Langzeitkontrollen nach spontanem Kontrastmittelextravasat bei Infusionsurogrammen.

In 1978 we described 18 patients with acute spontaneous rupture of a pelvi-calycine system; these have now been followed up with the exception of four patients. The aim was to determine whether, and how frequently, long-term complications occur, such as chronic persistent rupture and particularly whether local retroperitoneal fibrosis develops. The clinical history, infusion urograms and cinematography provided no evidence of any abnormalities except in one case. In this patient changes interpreted as retroperitoneal fibrosis were found, but this was the only patient in whom surgery had been performed. It is thought that the operation played a significant part in the development of this complication. Our observations confirm that infusion urograms in acute urinary tract obstruction are an acceptable method of investigation and that extravasation should be treated conservatively. The exception to this rule is the presence of preexisting infection of the urinary tract.