[Iodine-induced hyperthyroidism in the aged. 2. Pathomechanism, differential diagnosis and therapy problems]. / Jod-induzierte Hyperthyreose im Alter. Teil 2: Pathomechanismus, differentialdiagnostische und therapeutische Probleme.

The occurrence of multiple processes in elderly patients brings a high risk for diagnostic or therapeutic induced iodine-hyperthyroidism. Often an atypical form of hyperthyroidism without classical symptoms is induced. The cause of iodine-induced hyperthyroidism exists mostly in autonomous tissue beyond a "critical volume" in localized or disseminated form. If the deficiency of iodine in endemic goitre areas is substituted by iodine-application, hypermetabolism of autonomous tissue causes hyperthyroidism. The pathomechanism of autonomy and iodine-induced hyperthyroidism is not completely known. General iodine salt prophylaxis will bring less amounts of autonomous goitres. Some differential diagnostic possibilities for avoiding iodine-contamination in the elderly patients and therapeutic consequences after unavoidable iodine-application are described.

[Stress-ECG after myocardial infarct. Does myocardial infarct reduce the significance of stress ECG in the diagnosis of severe stenosis of the anterior interventricular ramus, the diagonal ramus and the marginal ramus of the coronary artery]. / Belastungs-EKH nach Hinterwand-Infarkt Schränkt ein abgelaufener Herzhinterwand-Infarkt den Aussagewert des Belastungs-EKG bei der Diagnose höhergradiger Stenosen des R. interventricularis anterior, R. diagonalis und R. marginalis der linken Koronararterie ein?

41 patients with inferior myocardial infarction underwent both exercise stress testing and coronary arteriography. Coronary arteriography of 15 patients showed high-degree stenosis as well as occlusions of the right coronary artery and/or of the R. circumflexus of the left coronary artery alone. In 14 of these 15 cases exercise stress testing showed a normal result, in one case results were abnormal. However, we detected additional high-degree stenosis of R. interventricularis anterior and/or of R. diagonalis and/or of R. marginalis in the other 26 patients. In 22 of these 26 cases exercise stress testing showed an abnormal result, in 4 cases it was normal. Because of a sensitivy of 84,6% and a specificity of 93,3% we can assume, that abnormal results of exercise stress testing suggest additional high-degree stenosis of the RIVA-vessel system in patient after inferior myocardial infarction. Considering an eventual bypass operation it is possible to narrow the indication for coronary arteriography.