An efficient method for the synthesis of sulbactam pivoxil.

Sulbactam pivoxil, a prodrug of the beta-lactamase inhibitor sulbactam, was prepared in high yield by reacting the sodium salt of sulbactam with chloromethyl pivalate in a polar solvent, then diluting the reaction mixture with water and isolating the product by filtration. Dimethyl sulfoxide was found to be the solvent of choice among several aprotic organic solvents.

Autoimmune thyroid disorders in juvenile chronic arthritis and systemic lupus erythematosus.

The appearance of autoimmune thyroiditis in the course of other autoimmune diseases, which do not affect specific organs (systemic lupus erythematosus, Sjögren syndrome, rheumatoid arthritis and others), is more frequent than is usually believed. Nevertheless, it is scarcely studied, especially in children. The purpose of this study was to look for autoimmune lesions of the thyroid gland in children suffering from juvenile chronic arthritis (JCA) and systemic lupus erythematosus (SLE). Twenty seven children having JCA and twelve children with SLE, aged 5 to 18 years, were enrolled into study. In all of them the disease was in an active phase. The serum levels of total thyroid hormones (T3, T4) and TSH, thyroid antibodies (TAB and MAB) and antinuclear antibodies (ANAB) were analyzed using respectively fluoroimmunologic, microhemagglutination and indirect immunofluorescention tests. According to our results, autoimmune thyroiditis was found in 12 out of 27 children with JCA (44.4%); 85.2% of them were euthyroid, 11.1% had a compensated hypothyroidism, and 3.7% had Hashi-toxicosis. From a clinical point of view, very interesting was the combination of JCA, autoimmune thyroiditis and pseudoxanthoma elasticum in a 13-year old girl. Positive thyroglobulin antibodies (1:80-1:5120) were found in 17 out of 27 cases of JCA (63%). The microsomal antibodies were elevated (1:100-1:1600) in 7 out of 27 (25.9%); antinuclear antibodies (1:80-1:640) were detected in 15 out of 27 cases of JCA (55.5%). A simultaneous elevation of all three kinds of antibodies was found in 14.8% of children with JCA, and of TAB and MAB--in 18.5%. Thyroid gland disorders were detected also in children suffering from SLE. Thyroglobulin antibodies were positive (1:80-1:5120) in 7 out of 12 cases. Antinuclear antibodies (1:320-1:2560) were detected in 8 out of 12 cases (66.7%). The serum levels of T3, T4 and TSH were in the reference limits in all children with SLE. The present study suggests that involvement of the thyroid gland is not uncommon in autoimmune disease in Autoimmune thyroiditis can occur in association with other autoimmune diseases, affecting some organs or systems, such as the insulin-dependent diabetes mellitus, pernicious anaemia, thrombocytopenia, vitiligo, as well as some chromosomal aberrations--Turner's syndrome, Noonan's syndrome and Down's disease [1]. The appearance of autoimmune thyroiditis together with other autoimmune diseases which do not affect specific organs (such as systemic lupus erythematosus, Sjögren syndrome) is the reason to classify them in a common subgroup of the autoimmune polyendocrine syndromes--type IIID [2]. The rheumatic diseases are--more frequently than suspected--associated with autoimmune thyroiditis, but this connection is not well studied. The literature offers very scarce information on the problem, especially for the childhood. The purpose of this study was to look for autoimmune lesions of the thyroid gland in children suffering from juvenile chronic arthritis (JCA) and systemic lupus erythematosus (SLE).

Neonatal TSH screening--an instrument of iodine supplementation monitoring in Bulgaria in comparison to Berlin--a preliminary report.

The challenge to eradicate iodine deficiency disorders (IDD) by the year 2000 worldwide will have positive consequences for more than 20 million people suffering from IDD. This is the main and common goal for the developing but also for a lot the developed countries. Sensitive tools like neonatal thyroid screening (NTS) can be used in order to make changes in iodine supplementation more transparent and to have a dynamic target oriented approach. The comparison between six districts in Bulgaria and Berlin revealed despite of some positive changes after the fortification of the iodine supplementation program still existing iodine deficiency in Bulgaria which is more profound than in Berlin in 1990. The shift to higher TSH-values in the Black-Sea region, classified by goitre-prevalence in 1956 as non-endemic for iodine deficiency, needs further investigation. Besides of iodine deficiency an influence of iodine-containing disinfectants and/or goitrogens is possible.

[Suicide with cesium-137]. / Suizid mit Caesium 137.

Reported first case of suicide with radioactive substance in Bulgaria. Male, aged 30, defectoscopist, with cyclothymic structure of character and psychotraumatic family environment made a second and successful attempt at suicide, this time by means of outer irradiation with cesium-137 with an activity of 5.3 curie in the course of two hours--irradiated his heart region and the first three fingers of his right hand. A grave picture of acute, local irradiation injury lasting four months with lethal outcome. The authors treat the psychological motives in the behaviour of these suicides and the reasons which determine the small number of suicide carried out with radioactive substance.