Prevalence of thyroid dysfunction in different geriatric subpopulations from a moderately iodine-deficient Hungarian region. Comparative clinical and hormonal screening.

The aim of this study was to investigate the prevalence of thyroid dysfunction in different geriatric subpopulations from a moderately iodine-deficient Hungarian region and to compare the efficacy of clinical versus hormonal screening. A screening study was done on 279 chronically ill geriatric patients (Group I) and 256 consecutive hospital admissions over 60 years of age (Group II). The method of clinical screening was different from those used so far: the object was not to search for symptoms of hypo- or hyperthyroidism but to find any sign justifying a further thyrotrophin-based biochemical evaluation, i.e. history of thyroid disease or goitre or any clinical sign of hormonal dysfunction. The rates of overt hypothyroidism, overt hyperthyroidism, subclinical hypothyroidism and subclinical hyperthyroidism discovered by the hormonal screening were 2.9, 1.1, 3.6 and 5.7% in Group I and 3.5, 2.3, 3.9 and 2.0% in Group II. The sensitivities of the clinical screening to suspect overt or overt+subclinical dysfunctions were, respectively, 0.82 and 0.64 in Group I and 1.0 and 0.7 in Group II (or 0.67 and 0.4 if the clinical investigation was done not by an endocrinologist but by the medical attendants). A primarily clinical investigation-based screening would have spared 171/279 thyrotrophin estimation in Group I and 161/256 in Group II, but would have missed 2/11 overt and 11/26 subclinical dysfunctions in Group I. In Group II, no overt but 9/15 subclinical dysfunctions would have been lost in this way. Our approach of a clinical investigation-based screening was rather efficient in suspicion of overt thyroid dysfunction but failed to detect many cases with subclinical dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

[Arthrosis of the distal radio-ulnar joint in workers using motorised saws (author's transl)]. / Arthrose des distalen radioulnaren Gelenkes bei Motorsägenbetreibern.

Vibration-induced changes in the distal radio-ulnar joint were analysed by comparing workers using motorised saws (978 cases) and a control group. The following are the essential findings: 1. Exposure to vibration causes characteristic changes in the distal radio-ulnar joint, particularly on the left, consisting of osteophytosis, deformity and cystic rarefaction. 2. The frequency of the arthrosis is related in a statistically significant manner to a) length of exposure, b) age. 3. The subjective complaints of numbness, weakness and pain can, to some extent, be related to the radio-ulnar arthrosis. 4. Vibration is not the only factor in the genesis of the degenerative process of the distal radio-ulnar joint; ordinary use and stress can cause similar changes, although to a much less marked extent. The aetiological role of local vibration as a factor in causing the arthrosis has been confirmed.

Tunnel syndromes of the upper extremities in workers using hand-operated vibrating tools.

Neurological and electrophysiological (EMG, ENG) examinations of the upper extremities were carried out in 167 patients exposed to hand-arm vibrations. All patients had typical symptoms (Raynaud's phenomenon and/or numbness, muscle weakness). The results showed that the circumscribed lesions of the tunnel nerves are far more common (92.8%) than diffuse peripheral neuropathies (22.7%). The most common alteration (71.4% below the border-line values) was the lesion of the brachial plexus in the thoracic outlet. In 16.2% of the patients compression of the subclavian artery was also demonstrated by means of a Doppler flowmeter. Cubital tunnel syndrome was observed in 42.5% of the patients. The results suggest that hand-arm vibration can play a part in the development of the thoracic outlet and cubital tunnel syndromes. On the other hand the thoracic outlet syndrome can contribute to the development of vibration-induced Raynaud's phenomenon.

[Some current questions concerning occupational diseases in Hungary]. / A foglalkozási betegek ellátásának néhány aktuális kérdése hazánkban.

The author reviews the management of the professional diseases in Hungary from the beginning till now. It can be stated that the number of the registered professional diseases in Hungary has decreasing steadily. He thinks that this tendency can be explained not only by the improvement of the labour higienic conditions and systematic screening tests with biologic monitoring but also by the increase of unemployment and the threatening of the latter of the workers as well as the lack of the discipline of the registration. The change of the economical structure resulted in the change of the problems concerning the professional diseases too. The liquidation of the old large factories and the development of many small economic plants represents a big problem of the labour hygienic control of the latters and make difficult the prophylactic examinations of all employees. This is a factor counteracting the further decrease of number of professional diseases. The change of the spectrum of the professional diseases is to be expected too. The criteria of the diagnosing, the therapy and the prognosis of the professional diseases are described. The most effective method of the medical prevention of the professional diseases in the precise fulfillment of the prophylactic medical examinations.

[An undying civilization damage: lead poisoning]. / Egy örökifjú civilizációs ártalom: az ólommérgezés.

The authors summarise the history, the sources, the pathophysiology, the symptoms and signs, the diagnostic methods, the differential-diagnostic possibilities, the therapy and prevention of the lead poisoning. They suggest that besides the classical professional and alimentary sources the environmental pollution caused first of all by leaded petrol plays a more and more important role in the lead exposure of the people. They draw the attention of the physicians to the lead intoxication as a possible cause of abdominal pain and/or anemia.

[Chronic perchloroethylene poisoning]. / Az idült perklór-etilén-mérgezés.

The authors describe the clinical features of the chronic perchloroethylene poisoning discussing their own 7 cases (2 women and 5 men). The 2 women worked as dry-cleaner, the 5 men performed degreasing of metal objects. The mean age of the patients was 46 (36-55), the exposure time 9.1 (0.5-30) years. In 3 cases the level of the exposure exceeded the maximum allowable concentration verified by the measurement of the perchloroethylene in the air of the workplace. One patient suffering from a serious cranial nerve lesion was not informed on the toxic exposure, so worked without any protective devices. 3 patients had an isolated lesion of the nervous system, 4 one an isolated hepatic damage. The authors draw attention to importance of the prevention.

[Acute appendicitis in a patient with increased lead absorption]. / Akut appendicitis fokozott ólomfelszívódásban szenvedó betegen.

The authors describe the case history of an acute appendicitis of a patient suffering from increased lead resorption. The operation resulted in complete healing. They draw the attention to the possibility of an acute abdominal disease also in case of abdominal complaints of patients suffering from increased lead resorption. Careful observation of the patient in collaboration with a surgeon is necessary to avoid a dangerous diagnostic error.

[Hand and arm vibration syndrome caused by mechanical screw driver]. / Csavarbehajtógép okozta kéz-kar vibrációs szindróma.

Authors performed angiological, neurological and radiological examination of 17 persons working with power screw-drivers. Vibration measurement of the tools was made too. 10 patients had symptoms and signs corresponding to the hand-arm vibration syndrome. The vibration of some tools exceeded the maximal allowable acceleration level according to ISO 5349. On the ground of the results authors conclude that some power screw-drivers can cause hand-arm vibration syndrome. The importance of choosing of the right tools and the significance of the periodical examinations are underlined in the prevention of the damages.

[Vibration-induced Raynaud phenomenon caused by an electric hedge trimmer]. / Bozótvágó adapter okozta vibrációs eredetü Raynaud-phenomen.

Authors observed Raynaud's phenomenon verified by cold-provocation test and measuring finger systolic blood pressure on a man working with bush cutter equipment installed on a tractor. Vibration measurements showed acceleration superior to maximal allowable level. Other causes of a secondary Raynaud's phenomenon were excluded by means of detailed internal examination. On the ground of the exposure data and lack of other ethiological factors the authors think that the patient had vibration-induced Raynaud's phenomenon. For prevention they proposed the diminishing of the daily exposure time and periodical medical examinations. They want to draw the attention for this sort of exposure.

[Hand-arm vibration syndrome in caisson miners]. / Kéz-kar vibrációs szindróma keszonvájárokon.

Authors examined 43 caisson-miners with symptoms of the upper extremities because of suspicion of hand-arm vibration syndrome. Also vibration measurements were performed on the pneumatic hammer used by the workers. The acceleration of the vibration exceeded 2.5-3.5 times the maximum allowable level according to the ISO 5349. Symptoms and signs of hand-arm vibration syndrome were found in 39 cases (90.7%). The vascular, peripheral neurological and locomotor system of the upper extremities were affected in similar frequency: 54.8; 51.6 and 51.2%, respectively. The most common angiological alteration was the Raynaud's phenomenon. Neurologically predominated the tunnel syndromes. Among the osteoarticular lesions the degenerative phenomena were the most frequent. In most cases more than one pathological alteration occurred. Fatigue fracture of the spinous process of vertebra D. I. appeared in one single case, degenerative changes of cervical spine in 34 patients (79.1%). The very common occurrence of the locomotor alterations and tunnel syndromes respectively can be explained probably also by the high physical stress required by this profession. The detailed examination of the locomotor system is very important by the periodical screening of the caisson-miners.

[Lead poisoning caused by lead-glazed ceramic household article, initially assumed to be of occupational origin]. / Kezdetben foglalkozási eredetünek imponáló familiaris alimentaris ólommérgezés ólommázas agyagedény háztartási használatát követóen.

The authors observed serious lead intoxication of a 18 year old female ceramic apprentice caused by tea with lemon stored in a glazed ceramic teapot made by the patient herself. The case history suggests: 1. the need of warning people to avoid the use of ceramic tablewares made by insufficient technology for alimentary purposes. 2. Patient with lead exposure can have also alimentary intoxication. 3. It seems advisable to perform screening tests of the ceramic apprentices who use lead glazes in order to detect the eventual increased absorption of lead in time.

[Microenvironmental lead poisoning]. / Mikrokörnyezeti eredetü ólommérgezések.

Authors describe two cases of lead poisoning of unusual origin. A 43 year old male patient bought some waste metal in order to build a fence around his new house for saving money. He removed the old corroded coat of paint using a grinder without any protection. Consequently, he had got grave lead intoxication with colic and anemia. Another 34 year old unemployed male person moulded leaded chessmen in his own kitchen. This activity resulted in serious intoxication of the patient and highly increased lead absorption of the family members. In addition to the exploration of professional exposure the authors stress also the significance of the clearing up of occasional lead-related hobbies and home activities in case of lead intoxication of unknown origin.

[Severe lead poisoning caused by an ingested fishing weight]. / Lenyelt horgásznehezék okozta súlyos ólommérgezés.

Authors describe the case-history of a 17 year old male who accidentally ingested a fishing weight that was retained in the stomach and caused a serious lead poisoning. It is worth mentioning that beside the wellknown symptoms and signs of lead intoxication also the liver was seriously affected. The histologically verified toxic lesion of the liver presumably can be attributed to the large quantities of lead absorbed within a short period. This also explains the appearance of symptoms and signs indicating to encephalopathy beside the young age of the patient. The foreign body could not be removed by means of gastroscopy, therefore a gastrotomy was carried out followed by chelating treatment with i.v. CaNa2EDTA that resulted in complete clinical and laboratory recovery. The case history draws the attention to the importance of the quick removal of the retained lead containing objects out of the gastrointestinal tract.