[Where does subclinical hypothyroidism start? Implications for the definition of the upper reference limit for thyroid stimulating hormone]. / Wo beginnt die subklinische Hypothyreose? Implikationen zur Definition der oberen Referengrenze für Thyreotropin.

UNLABELLED: The upper limit of the TSH reference range is currently under discussion. In its recent guidelines, the National Academy of Clinical Biochemistry (NACB) recommended the use of approximately 2.5 mIU/L, rather than approximately 4 mIU/L, due to the fact that reference populations, on which the definition of the reference range is based, contain persons undergoing an initial phase of autoimmune thyroid disease. This will skew the upper reference limit of TSH. Ultrasonography, in addition to measurement of thyroid autoantibodies, should be used to exclude these persons. OBJECTIVE: The present study investigates whether the NACB recommendation also applies for a region of mild iodine deficiency. METHODS: According to NACB criteria, a reference population (713 persons) was defined out of a total study population of 1442. The TSH reference range was calculated in this reference group and in further subgroups by percentiles. The results were compared with the total study population and the NACB recommendation. All assays used were provided by BRAHMS Diagnostica AG, Hennigsdorf, Germany. RESULTS: As expected, all median TSH values, excluding the median of the group with a hypoechogenic thyroid were close to 1.2 mIU/L. The 97.5th percentile in the reference population was 3.35 mIU/L. However, there was no difference compared to the total study population. CONCLUSION: The upper reference limit for TSH based on a reference population according to NACB criteria came down to 3.35 mIU/L, but not to approximately 2.5 mIU/L. Interestingly, there is no difference compared to the total study population.

Radioactivity in gastric juice-a simple adjunct to the Yb-169 DTPA cisternographic diagnosis of CSF rhinorrhea: concise communication.

A new method is offered as an adjunct to radionuclide cisternography and the measuring of radioactivity in nasal pledgets. The activity in gastric juice following the intrathecal injection of Yb-169-DTPA is measured and the ratio of gastric juice to blood is calculated. In patients suffering from CSF rhinorrhea the ratios significantly exceed the normal range. This method can be used to detect CSF leakage at the back of the nasopharynx, and in patients with head injuries too severe to permit the use of nasal pledgets.

[Sources of error in the interpretation of bone scans with 99mTc-diphosphonate (author's transl)]. / Fehlermöglichkeiten bei der Interpretation der Knochenszintigramme mit 99mTc-Diphosphonat

Errors in the interpretation of bone scans with 99mTc-diphosphonate may be due to summation of radio-activity from superimposition of various bone structures. Lesions with increased bone turn-over as well as reactive hyperaemia result in increased uptake. The possibility of extraosseous uptake of diphosphonate must be borne in mind during the evaluation of bone scans. The kidneys and lower urinary tract must be considered. Absent or slight uptake by the kidneys with good demonstration of bone suggests increased diphosphonate uptake by the bones. Special attention should also be paid to zones of decreased uptake, since these are also due to abnormalities in the bone.

Intrathecal therapy with 198Au-colloid for meningosis prophylaxis.

Telecobalt irradiation in combination with intrathecal (IT) methotrexate has been replaced by IT 198Au-colloid and methotrexate for meningosis prophylaxis in leukemia. Seventy-seven children received 56-200 MBq 198Au-colloid. The distribution was measured with a scintillation camera having a data processing facility. The radiopharmaceutical is adsorbed at the surface of the spaces with cerebrospinal fluid (CSF) 10-20 h after application. The normal retention of the administered radioactivity in the intracranial subarachnoid space (ISS) and in the spinal subarachnoid space (SSS) were 52 +/- 10% and 26 +/- 9%, respectively. An impairment of the normal distribution was observed after IT methotrexate and also postinjection CSF leakage. The calculated radiation absorbed doses in the cerebral and spinal meninges at a depth of 0.01 cm, i.e. the thickness of the pia, were 45 +/- 17 mGy and 189 +/- 91 mGy, respectively, for 1 MBq administered 198Au-colloid. The dosimetry shows that an effective radiation absorbed dose of 18 Gy can be delivered to the cerebral meninges by the application of 400 MBq 198Au-colloid.

[Function of the liver reticuloendothelial system in hemorrhagic shock in dogs]. / Funktionsprüfung des Leber-RES im hämorrhagischen Schock bei Hunden

The function of hepatic reticulo-endothelial system at normal circulation and during hemorrhagic shock was examined in 13 dogs. The results were as follows:1.198Au-colloid liver scintigraphy demonstrated no essential alterations by shock. A trifling diminution caused by the diminished blood amount in the liver was found at heavy blood loss. The spleen was opcified in no case. 2. The elimination rate, resp. the blood clearance, of 198Au-colloid remained constant during the first 2 hours, proving that the vital clearance function of hepatic reticulo-endothelial system is completely maintained in this phase of hemorrhagic shock. After longer duration of hypovolemic shock (5 hours) elimination rate decreased. 3. It can be concluded that hepatic circulation at first alters according to the blood volume. 4. Consequently, functional testing of hepatic reticulo-endothelial system is not fit for early diagnosis of shock.

[Primary malignant lymphoma of the central nervous system]. / Primäres malignes Lymphom des Zentralnervensystems.

Clinical and morphological observation of 56-year-old man with a primary isolated malignant non-Hodgkin's lymphoma of the central nervous system in the hypothalamus, with the formation of metastases in the space of the cerebrospinal fluid and a solitary extraneural metastasis in the epicardium. No generalised lymphoma. The histological classification is discussed. The importance of the cytology of the cerebrospinal fluid to a climical diagnosis is pointed out.

[Bone scintigraphy following cryodevitalization of the mandible]. / Knochenszintigraphie nach Kryodevitalisation der Mandibula.

A tumor of the mandible can be destroyed successfully by cryogenic devitalisation. The revitalisation process was observed in 6 miniature swines by means of nuclear medical bone exploration. The bone metabolism decreased clearly postoperatively, and indeed laterally more than lingually. An increased blood flow and bone metabolism was recognized as an expression of the repair process at the border to the healthy bone after 7 days, later also lingually whereas no reaction was found laterally. The extent of the devitalised bone was 0.5-1.0 cm bigger than the cryosurgical part.

[Follow-up studies of patients with negative TRH test and normal thyroid hormone levels]. / Verlaufsbeobachtungen bei Patienten mit negativem TRH-Test und normalen Schilddrüsenhormonspiegeln.

The aim of the study was to assess the clinical significance of the association of a negative TRH-test with normal thyroid hormone levels. Therefore, we repeated the investigation in 63 patients one year after the first examination. In 6 patients (10%) hyperthyroidism had developed. Euthyroid autonomy was diagnosed in 11 patients (17%). A prolonged normalisation period of the pituitary-thyroid regulation after having discontinued the thyroid hormone drugs was found in 7 patients (11%). In 40% of the patients the TRH-test remained negative and in 22% of the patients the TSH-response became positive without any known reason. The findings show that a negative TRH-test and normal thyroid hormone levels do not necessarily imply subclinical hyperthyroidism.

[Value of sonography in assessing nodular changes of the thyroid in an endemic goiter area]. / Zur Wertigkeit der Sonographie für die Beurteilung nodöser Schilddrüsenveränderungen im Strumaendemiegebiet.

In an area of endemic goiter 304 patients with an increased thyroid gland were examined by palpation, sonographically and partly scintigraphically. The average age was 37 (12-78) years, the average age of the patients with nodular changes of the thyroid gland 38-44 years. Patients with a diffuse struma were significantly younger with an average age of 33 years. A false-positive enlargement of the thyroid gland established by palpation occurred in 16.1% (n = 49/304). In the sonographic examination 148 out of 304 patients revealed a diffuse enlargement of the thyroid gland without provable nodular change. However, in about one third already more or less clearly characterized regressive changes could be observed. In 156 of the 304 patients 109 times solitary nodes and 47 times multinodular changes were established sonographically. In more than one third of all nodular goiters or one fifth of all patients examined a cyst was demonstrated sonographically. Two thirds of the sonographically established nodular changes were, however, solid. In 53 of all 304 examined patients could sonographically be established additional, unexpected nodes which had escaped the palpation and partly also the scintigraphic investigation. In 14% the node suspected by palpation could not be ascertained sonographically. According to the echo structure echo-poor and echo-equal solid nodes dominated. The frequency of carcinomata of the solid nodes was 6.7%. Apart from 4 echo-poorly and 2 complexly structured nodes a carcinoma of the thyroid gland demonstrated itself sonographically to the same echo. Finally conclusions are drawn for the diagnostics of the thyroid gland in the endemic area of goiter.