Autonomic neuropathies in skin and its incidence in non-insulin-dependent diabetes mellitus.

The autonomic function of nerve fibres was investigated with the newly developed hyperthermal Laser-Doppler-Flowmetry in 45 patients suffering from Non-Insulin-Dependent Diabetes Mellitus (NIDDM). They were divided into 3 groups depending on the duration of NIDDM. Group A contained a duration of 1-3 years, group B 4-5 years and group C 5-6 years. All groups showed a dysfunction of autonomic nerve fibres: in group A there were 4 of 11 patients, in group B 2 of 13 and in group C no patients with values within the normal ranges. So autonomic neuropathies of skin seem to be one of the earliest complications in NIDDM

Transient prealbumin-associated hyperthyroxinemia in TSH-producing pituitary adenoma.

This case report describes a 38-year-old male who was hospitalized for further clarification of clinically mild hyperthyroidism. His increased total hormone levels, the elevated free thyroid hormones and the elevated basal TSH with blunted response to TRH strongly suggested a pituitary adenoma with inappropriate TSH incretion. Transmission computed tomography showed an intrasellar expansion, 16 mm in diameter. The neoplastic TSH production was confirmed by an elevated alpha-subunit and a raised molar alpha-sub/TSH ratio. However, T4 distribution on prealbumin (PA, TTR), albumin (A) and thyroxine binding globulin (TBG) showed a clearly increased binding to PA (39%), indicating additional prealbumin-associated hyperthyroxinemia. The absolute values of PA, A and TBG were within the normal range. After removal of the TSH-producing adenoma, basal TSH, the free thyroid hormones and T4 binding to prealbumin returned to normal. Therefore, the prealbumin-associated hyperthyroxinemia had to be interpreted as a transitory phenomenon related to secondary hyperthyroidism (T4 shift from thyroxine binding globulin to prealbumin) rather than a genetically conditioned anomaly of protein binding.

[Microcirculation in parenteral Ginkgo biloba extract therapy]. / Die Mikrozirkulation unter parenteraler Ginkgo-biloba-Extrakt-Therapie.

15 patients with arteriosclerotic lesions in the extracranial brain arteries, randomly selected, were treated with an infusion of 250 ml physiological NaCl and 25 ml Ginkgo biloba extract (Tebonin). A second group (n = 15) received 250 ml NaCl without drugs stimulating blood flow. The skin microcirculation was measured in vivo by means of a helium-neon laser at one of the 4 extremities. Perfusion increased significantly (p less than or equal to 0.01) in response to Ginkgo biloba extract als composed with the response in the control group. The results justify the administration of Ginkgo biloba extract in vascular diseases.

[Ginkgo biloba extract and folic acid in the therapy of changes caused by autonomic neuropathy]. / Ginkgo-biloba-Extrakt und Folsäure in der Therapie von autonomen neuropathischen Veränderungen.

10 patients suffering from neuropathies caused by various diseases and with an autonomic disregulation of skin were treated intravenously with a new combination of 87.5 mg Ginkgo-biloba-extract standardized to 21.0 mg Flavonglycosids and 3 mg folic acid during 14 days. The autonomic nerve-function was measured immediately before onset and after the end of therapy with the hyperthermal laser-Doppler-Flowmetry. Additionally pain, superficial and deep sensibility were described. After the end of treatment the autonomic nerve-function was improved in a significant manner (p less than 0.01). An improvement of the described parameters for pain and for perception could be observed too. Therefore this new combination seems to be suited for treatment of polyneuropathies.

Calcium dobesilate and its effects on hemorheology and microcirculation.

In series, 50 patients suffering from cerebral (n = 33) and peripheral (n = 17) diseases were treated with 3 x 500 mg calcium dobesilate (Doxium) per day. Before onset of therapy and after 14 days the viscoelasticity of whole blood and plasma as well as hematocrit and microcirculation at the finger pad were measured. Viscoelasticity of whole blood, plasma and hematocrit decreased in a significant manner (p less than or equal to 0.001), while microcirculation increased significantly (p less than or equal to 0.001). The results justify the application of calciumdobesilate for ischemic diseases with elevated viscosity.

Hypothyroidism and the influence on human blood rheology.

Viscoelastic properties of human whole blood were measured in 338 subjects: 110 persons (75 F, 35 M) following total thyroidectomy but without substitution therapy over three weeks as well as 228 healthy control subjects (124 F, 104 M) were investigated in this study. Subjects with other variable factors were excluded. The viscous and the elastic portion of apparent whole blood viscosity -the latter subdivided into red cell aggregation and red cell rigidity were determined by using a newly developed oscillating capillary rheometer and densitymeter at the real hematocrit value and at a computed hematocrit of 40%. Serum viscosity, hematocrit (Hct), hemoglobin (Hb), mean corpuscular volume of red blood cells (MCV), free triiodothyronine (fT3), free thyroxine (fT4) and serum-thyrotropin (bTSH) were evaluated as well. In a further subgroup of 80 subjects (40 patients with hypothyroidism, 40 healthy control persons) additional plasma viscosity and sedimentation rate were determined. Red cell aggregation and blood viscosity especially at shear-rates below 10/sec increased significantly in hypothyroid patients. There was no significant difference of red cell rigidity, serum viscosity, plasma viscosity and sedimentation rate as against euthyroids. So new aspects of thyroid dysfunction could be described probably with consequences for therapy and for considerations about the development of atherosclerosis and ischemic disorders.

[The acute hemorheologic effect of calcium dobesilate]. / Der hämorheologische Akuteffekt von Kalziumdobesilat.

In a series 40 subjects without manifest vascular disorders received 1000 mg Calcium dobesilate (Doxium). Before and 3 hours after application the viscoelasticity of whole blood as well as plasma viscosity and the hematocrit were determined. The statistical analysis was performed by Wilcoxon-test. The viscosity of whole blood and the hematocrit decreased with a significance of p less than or equal to 0.001, whereas the elasticity decreased in a significance manner of p less than or equal to 0.01. Plasma viscosity remained uncharged. The results show an effect of hemodilution, which could be very important for treatment of hyperviscosity.

[Method for the determination of protein binding of thyroid gland hormones and the detection of antibodies to T4 and T3]. / Methode zur Bestimmung der Proteinbindung der Schilddrüsenhormone und zum Nachweis von Antikörpern gegen T4 und T3.

More than 99% of circulating thyroid hormones are bound with defined capacity and affinity to transport proteins such as thyroxine binding globulin, albumin and prealbumin. Variants of albumin and/or prealbumin, often familial, will bind T4 and sometimes T3 with increased affinity causing higher TT4 and TT3 values respectively. In determining fT4 and fT3 by analogue tracer its binding to protein variants will also lead to falsely raised free parameters. Thus the possibility of a false diagnosis of hyperthyroidism arises. Also the presence of T4 and T3 autoantibodies will cause misleading findings of increased thyroid hormone parameters as against euthyroid metabolism. For determining the pattern of T4 and T3 protein binding as well as autoantibodies radioactive labelled T4 or T3 is incubated with the patients serum. Transport proteins are separated by means of horizontal agarose gel electrophoresis with water cooling. The gel is sectioned and the activity of individual gel particles is measured in a Gammacounter. The activity graph shows with high precision the binding pattern of T4 and T3 to transport proteins. Moreover, this method also serves to determine any possible T4 and T3 autoantibodies, indicated by a peak in the activity graph in the gamma globulin range.

[Prealbumin-associated hyperthyroxinemia]. / Präalbuminassoziierte Hyperthyroxinämie.

Prealbumin associated hyperthyroxinaemia represents a rare but important protein binding anomaly, causing difficulties in differential diagnostics. This anomaly is based on a variant prealbumin showing an increased affinity to T4 and rT3 and in some cases also when using T4 analogue tracers. The condition of the patient is clinically euthyroid which is confirmed by a normal bTSH level, a normal response to TRH, and peripheral parameters (BMR, ASR, STI, SHBG) in the euthyroid range. This paper describes the diagnostic difficulties in a 45-year-old male pointing out the significance of precise laboratory determination of prealbumin associated hyperthyroxinaemia in order to avoid misdiagnosis and wrong treatment.

[Diagnosis of peripheral thyroid hormone effect using sex hormone-binding globulin (SHBG) and systolic time intervals (STI)]. / Diagnostik der peripheren Schilddrüsen-hormonwirkung mittels Sex-Hormone-Binding-Globulin (SHBG) und systolischer Zeitintervalle (STI).

Only in rare cases with peripheral resistance to thyroid hormones, low T3 syndrome and inappropriate TSH secretion a laboratory determination of the effects of thyroid hormones on peripheral organs such as BMR, Achilles sinew reflex, cholesterol, SHBG, STI etc. is necessary. It was demonstrated that serum concentration of SHBG offered a clear and reliable parameter of the effects of thyroid hormones on liver cells. In a group of 31 patients with overt hyperthyroidism the level of SHBG being 136.5 nmol@l was significantly higher (p less than 0.001) than in control patients showing 36.3 nmol/l SHBG. The hypothyroid group (32 patients) showed a rather significant reduction (p less than 0.01) in SHBG level with a median of 27.5 nmol/l. Among the systolic time intervals the preejection period (PEP) and the LVET/PEP ratio were the most striking parameters. In the hyperthyroid group there was a highly significant shorter interval of PEP (p less than 0.001) and a significant rise of the LVET/PEP ratio (p less than 0.01) compared with the control patients. In the hypothyroid group a hardly perceptible extension of PEP (p less than 0.01) was observed, but a highly significant decrease of the LVET/PEP ratio (p less than 0.001) could be demonstrated.

[Urinary excretion of iodide and incidence of goiter in Styria--studies 20 years after the introduction of compulsory iodinated salt prophylaxis]. / Harnjodidausscheidung und Strumahäufigkeit in der Steiermark--Untersuchungen 20 Jahre nach gesetzlicher Einführung der Jodsalzprophylaxe.

20 years after introduction of iodized salt prophylaxis by law in Austria the iodine supply of 6 to 19 year-old school children in Styria was examined. In this study we compared the goitre incidence and urine iodine excretion in children from regions with low iodine intake (locations Graz and Oberwölz) with those of an area where iodine supply was augmented by drinking local iodine containing mineral water (area of Sicheldorf). A modified ceric ion arsenate method was applied for determining urinary iodine excretion. Both in the city of Graz and the rural locality of Oberwölz there still exists an iodine deficiency, grade I (Urine iodine excretion of 50 and 65 micrograms I/g Cr respectively). The goitre incidence in 6 to 10 year olds in Graz amounted to only 4%, while Oberwölz records 8%. This figure in juveniles was relatively high already with 12% in Graz and 15% in Oberwölz. The age group of 15 to 19 years at the Graz secondary school showed a goitre incidence of 12%. The results of the 6 to 10 year olds in the Sicheldorf area recorded a goitre incidence of 4%. Urinary iodine excretion in Sicheldorf: 132,64 micrograms J/g Kre.