Antibacterial and antiplaque efficacy of a lactoperoxidase-thiocyanate-hydrogen-peroxide-system-containing lozenge.

BACKGROUND: Antimicrobial agents are considered valuable adjuncts to mechanical methods of plaque control. However, their long-term use can be limited because of side effects. Therefore, using physiological substances is promising due to no risk of development, for example, of microbial resistances, allergies or DNA damaging. The lactoperoxidase-thiocyanate-hydrogen peroxide system (LPO-system) is a highly effective antimicrobial system. This study aimed to evaluate in a randomized study with a four-replicate cross-over design the effectiveness of two oral hygiene lozenges containing LPO-system in oral hygiene. RESULTS: After using the mouth rinse as positive control (A) and allocated test lozenges (B) (0.083% H2O2) & (C) (0.04% H2O2) for 4 days instead of the normal oral hygiene procedures (tooth brushing etc.), Listerine rinse (A) was statistically significantly more effective than the LPO-system-lozenge with 0.083% H2O2, the LPO-system-lozenge with 0.04% H2O2, and the placebo lozenge (D) in inhibiting plaque. Lozenges B and C were statistically significantly more effective than the placebo lozenge, but no statistically significant differences could be observed between them. The LPO-system-lozenge (B) reduced statistically significantly more S. mutans than the LPO-system-lozenge with (C) and the placebo lozenge (D). The LPO-system-lozenge (C) reduced statistically significantly more Lactobacilli than Listerine (A), the LPO-system-lozenge (B) and the placebo lozenge (D). There were no statistically significant differences in the total CFUs between Listerine rinse, the LPO-system-lozenge with 0.083% H2O2 (B), the LPO-system-lozenge with 0.04% H2O2 (C), and the placebo lozenge (D). On day 5 there were no differences of the OSCN--values between all A, B, C, and D. However, the SCN--values increased over the days in both LPO-system-lozenges (B/C). The statistically significant differences between B/C and A/D on day 5 were as followed: A to B p = 0.0268; A to C p = 0.0035; B to D p = 0.0051; C to D p = 0.0007. Only in the group of Listerine (A) increased the NO3-/NO2--quotient over the test time, which indicates a reduction of nitrate-reducing bacteria. On Day 5 the statistically significant difference between A and B was p = 0.0123. CONCLUSIONS: The results indicate that lozenges containing a complete LPO-system, inhibiting plaque regrowth and reducing cariogenic bacteria, may be used in the daily oral hygiene.

Do pneumatic tube transport systems transmit potential pathogens? A hygienic risk assessment in a university hospital.

BACKGROUND: Prompted by an outbreak of vancomycin-resistant enterococci (VRE) in a medical facility, this study examined a pneumatic tube transport system (PTS) as a potential transmission channel. METHOD: Samples from the receiving station and entry racks were gathered via smear technique. Sponges used for PTS decontamination were soaked with 0.89% NaCl and transported through the channel. Micro-organisms were recovered from the tubes and cleaning sponges using a wash-away technique. Air sampling was performed at the receiving station in order to detect any airborne contamination. Tubes were artificially inoculated with Escherichia coli K12 NCTC 10538 and Staphylococcus epidermidis DSM 20044 and sent through the PTS to investigate channel contamination. RESULTS: No pathogens were detected in effluent air from the PTS or in tubes during routine operation. Entry racks for the test tubes were contaminated with coagulase-negative staphylococci (CNS), aerobic bacilli, moulds and vancomycin-susceptible Enterococcus faecium. E. coli proved to be unsuitable for detecting bacterial transmission by the PTS due to low persistence, but S. epidermidis was more resilient. After sending contaminated test tubes through the PTS, levels of S. epidermidis only decreased marginally. Subsequently, sponges soaked with disinfectant solution were put through the system and these eliminated S. epidermidis completely from the first attempt. DISCUSSION: Routine hygienic maintenance of the PTS makes pathogen transmission highly unlikely, although entry racks should be disinfected regularly. Any involvement of the PTS in the VRE outbreak at the study institution was unlikely.

Measurements of chlorhexidine, p-chloroaniline, and p-chloronitrobenzene in saliva after mouth wash before and after operation with 0.2% chlorhexidine digluconate in maxillofacial surgery: a randomised controlled trial.

Chlorhexidine gluconate is used to prevent the accumulation of dental plaque and gingivitis, infection of the surgical site, and ventilator-associated pneumonia in maxillofacial surgery, but it is not clear whether the metabolites of chlorhexidine are detectable in the patient's saliva at clinically relevant concentrations. Forty-three patients who had orofacial operations were randomised to use a 0.2% chlorhexidine gluconate (n=23), or an octenidine-based, chlorhexidine-free (n=20), mouthwash once preoperatively and three times daily for five postoperative days. After the first, 8.7 (23.3) mg/L chlorhexidine (0.7%-2.5% of the total amount used) was measured in saliva. The concentration increased to 15.2 (6.2) mg/L after the second rinse (first postoperative day), and peaked at 29.4 (11.2) mg/L on the fourth postoperative day. It remained detectable for up to 12hours after the last one, but was not detectable in serum or urine at any time. The potentially carcinogenic metabolite p-chloroaniline was detectable in saliva at higher concentrations in the chlorhexidine group (0.55mg/L) than the octenidine group (0.21mg/L), and p-chloronitrobenzene was detected in both groups in only minimal concentrations (0.001-0.21mg/L). Chlorhexidine gluconate mouthwashes do increase the concentration of p-chloroaniline, but a single use seems to be safe. Whether prolonged exposure over many years may have carcinogenic potential is still not clear. Based on the hitherto unknown kinetics of p-chloroaniline in saliva, the recent recommendation of the Federal Drug Administration (FDA) in the USA to limit the use of a chlorhexidine gluconate mouthwash to a maximum of six months seems to be justified.

[TSH-reference range of adults: results from the population-based study KORA F4]. / TSH-Referenzbereich bei süddeutschen Erwachsenen: Ergebnisse aus der bevölkerungsbasierten KORA F4-Studie.

INTRODUCTION: There is no valid nationwide reference value for Thyroid-stimulating hormone (TSH) for German adults because of different iodine supply and different laboratory equipment, however, reference values for single regions of Germany have been defined. The aim of this study was to find a reference value for South Germany and to compare this with results of other population-based studies. METHODS: 3080 individuals from the KORA-F4 study (Cooperative Health Research in the Region of Augsburg) at the age range of 32 to 81 years were examined regarding their thyroid characteristics (anamnesis, sonography and clinical chemistry). After excluding individuals with known as well as unknown thyroid disorders revealed by the KORA study, there were 710 thyroid-healthy individuals left to evaluate TSH-, fT3- and fT4-reference ranges. RESULTS: For thyroid-healthy men and women we evaluated a TSH-reference range of 0.52-3.60 mIU/l on Siemens Vista Analysers with a median of 1.49 mIU/l. We could not find any statistically significant influence of age or sex. Median iodine excretion in urine was 118.6 µg/g creatinine in our healthy population which is above the recommended target value of 100 µg/g. DISCUSSION: The TSH-reference value of the South German population is higher than the one assessed in the Northeast-German SHIP-study 10 years ago. For the definition of a TSH-reference value, population-based and apparatus-specific examinations are necessary.

Geographic variations in the frequency of thyroid disorders and thyroid peroxidase antibodies in persons without former thyroid disease within Germany.

OBJECTIVE: To investigate regional variations in the frequency of undiagnosed thyroid disorders among 25- to 88-year-old men and women in two communities in the northeast and the south of Germany. In addition, autoantibodies to thyroperoxidase (TPO-Abs) and urinary iodine excretion were determined. METHODS: Two population-based surveys of men and women using a common standardized protocol, the Study of Health in Pomerania (SHIP) in the northeast of Germany (2505 participants) and the Kooperative Gesundheitsforschung in der Region Augsburg (KORA) in the south of Germany (2316 participants), were compared with regard to the frequency of undiagnosed thyroid disorders. RESULTS: Compared with the northeast of Germany, urinary iodine excretion and serum thyroid-stimulating hormone (TSH) levels were significantly higher in the south. The median urinary iodine concentration was 110 µg/l (64; 169 µg/l) in SHIP and 151 µg/l (97; 214 µg/l) in KORA, and the median TSH value was 0.81 mIU/l (0.56; 1.15 mIU/l) in SHIP and 1.22 mIU/l (0.84; 1.80 mIU/l) in KORA. The frequency of elevated TSH (TSH ≥ 2.12 mIU/l) was 4.3% in SHIP and 14.1% in KORA (P<0.001); the corresponding values for suppressed TSH (<0.25 mIU/l) were 3.5 and 1.7% (P<0.001). The proportion of ultrasonographic findings was 55.5% in SHIP and 68.0% in KORA. The frequency of serum TPO-Abs did not differ significantly between northeast and south Germany. CONCLUSIONS: There were considerable regional disparities in the frequency of thyroid disorders within Germany. These differences can be explained not only by different regional histories of natural iodine deficiency but also by current differences in the iodine supply under an identical nationwide iodine fortification program.

Microbicidal efficacy of thiocyanate hydrogen peroxide after adding lactoperoxidase under saliva loading in the quantitative suspension test.

OBJECTIVE: As shown in the quantitative suspension test adding lactoperoxidase to a thiocyanate (SCN(-)) hydrogen peroxide (H(2)O(2)) combination over the physiological saliva level has significant positive antimicrobial effects to a level of totally killing Streptococcus mutans, Streptococcus sanguinis, and Candida albicans. The aim of this study was to evaluate this positive effect under human saliva loading. METHODS: The bactericidal and fungicidal effect of lactoperoxidase was evaluated in a quantitative suspension test by using two test mixtures of a 2.0% thiocyanate and 1.2% hydrogen peroxide solution, one without (Group A) and one with (Group B) lactoperoxidase under saliva loading. Following the quantitative suspension tests (EN-13727/EN-13624), the growth of surviving bacteria and fungi in a nutrient broth was measured. The exposure times were restricted to 1, 3, 5, and 15 min. All statistical analyses were carried out with SPSS 11.5. RESULTS: In the quantitative suspension test, the combination of thiocyanate and hydrogen peroxide showed relatively low antimicrobial effectiveness on S. mutans, S. sanguinis, and C. albicans in the presence of human saliva at measured time points in comparison to the mixture with lactoperoxidase, which showed a high bactericidal activity within 15 min (S. mutans and S. sanguinis) and fungicidal activity within 3 min (C. albicans). CONCLUSION: The antimicrobial effectiveness of the tested thiocyanate hydrogen peroxide combination was increased significantly by adding lactoperoxidase in the quantitative suspension test under human saliva loading.

[Influence of floor disinfection on microbial and particulate burden measured under low turbulance air flow in ophthalmological operation theatres]. / Einfluss der Fußbodendesinfektion auf die mikrobielle und partikuläre Belastung der Raumluft in Augen-OP-Räumen mit Verdrängungslüftungsbereichen.

AIM: The necessity for routine disinfection of floors between two surgical procedures or disinfection only after visible contamination was assessed in two identical ophthalmological operating theatres equipped with laminar air flow ventilation. METHOD: Over a period of four weeks, one of the two tested operating rooms was disinfected after every surgical procedure, and the other only in the case of visible contamination. This regimen was inverted every week. To compare the air quality, particle count and total bacteria count were measured inside and outside the laminar air flow. Additionally, bacteria count was measured in the operating field, consisting of the operating table and the instrument tray. Patients were monitored for surgical site infection over a period of one year after operation. RESULTS: No difference in particle count or number of viable bacteria was found between the two investigated procedures. Also, no wound infections were observed after one year of surveillance for surgical site infection. CONCLUSION: It appears that frequent cleaning disinfection of floors is not necessary if a laminar air flow ventilation system is installed. Under these conditions, targeted disinfection of visibly soiled surfaces appears to be sufficient. Generally, the duration of surgical procedures should be kept as short as possible.

[Importance of displacement ventilation for operations and small surgical procedures from the infection preventive point of view]. / Infektiologische Bedeutung von Raumlufttechnischen Anlagen (RLTA) in Operations- und Eingriffsräumen.

Surgical teams need to breathe air that is conducive to their health. An adequate exchange of air ensures oxygen supply, the ventilation of humidity, smells, toxic substances, especially narcotic gases and surgical smoke, pathogens and particles. With regard to the infection risk, DIN 1946 / 4 -differentiates between operation theaters with the highest demand for clean air (operation room class I a), operation theatres with a high demand (operation room class I b) and rooms within the operation theatres without special requirements, meaning that the microbial load in the air is close to or equal to that of normal in-room air quality (room class II). For an operation room class I a, ventilation that displaces the used air is necessary, while a regular ventilation is sufficient for operation room class I b. Because of ambiguous -results in previous studies, the necessity to define a -class I a for operation rooms is being questioned. Therefore, this review focuses on the analysis of the existing publications with respect to this -question. The result of this analysis indicates that so far there is only one surgical procedure, the -implantation of hip endoprosthetics, for which a preventive effect on SSI of a class I a ventilation (displacement of the used air) is documented. One recent study, reviewed critically here, -showed opposite results, but lacks methodological clarity. Thus, it is concluded that evidence for the requirement of operation room classes can only be derived from risk assessment (infection risk by surgical intervention, extent of possible damages), but not from epidemiological studies. Risk assessment must be based on the following criteria: size and depth of the operation field, -duration of the procedure, vascular perfusion of the wound, implantation of alloplastic material and general risk of the patient for an infection. From an infection preventive point of view, no class I a "displacement ventilation" is necessary for small surgical procedures for which the RKI recommends only a procedure room, and for surgical procedures for which a risk evaluation indicates that the air in the operation theater can be equal to normal air.

Urinary iodide excretion in adults in germany 2005 meets WHO target.

BACKGROUND: Recent regional and germanwide investigations have shown that the abolition of the requirement to declare iodine in foodstuffs and the greater emphasis on information about goitre prevention led to an increase in urinary iodine excretion in German schoolchildren. There was also a decrease in thyroid size and goitre prevalence in children. No up to date results in adults for the whole of Germany are available. METHODS: In 2005 we examined the urinary iodine excretion in the spontaneous morning urine of 1 538 healthy adults in 357 places from all over Germany. The iodine was measured by the Cer- arsenit method. RESULTS: The median iodine excretion amounted to 132 microg/l. There were no significant differences between age groups, sexes or regions. 64% had no iodine deficiency (>100 microg/l). In 23% the deficiency was slight (50-99 microg/l), in 10% moderate (20-49 microg/l) and in 3% there was severe iodine deficiency (<20 microg/l). 29% excreted >200 microg iodide per litre urine. CONCLUSION: According to the WHO guidelines, there is no longer an iodine deficiency in German adults.

Effect of lactoperoxidase on the antimicrobial effectiveness of the thiocyanate hydrogen peroxide combination in a quantitative suspension test.

BACKGROUND: The positive antimicrobial effects of increasing concentrations of thiocyanate (SCN-) and H2O2 on the human peroxidase defence system are well known. However, little is known about the quantitative efficacy of the human peroxidase thiocyanate H2O2 system regarding Streptococcus mutans and sanguinis, as well as Candida albicans. The aim of this study was to evaluate the effect of the enzyme lactoperoxidase on the bactericidal and fungicidal effectiveness of a thiocyanate-H2O2 combination above the physiological saliva level. To evaluate the optimal effectiveness curve, the exposure times were restricted to 1, 3, 5, and 15 min. RESULTS: The bactericidal and fungicidal effects of lactoperoxidase on Streptococcus mutans and sanguinis and Candida albicans were evaluated by using two test mixtures of a 2.0% (w/v; 0.34 M) thiocyanate and 0.4% (w/v; 0.12 M) hydrogen peroxide solution, one without and one with lactoperoxidase. Following the quantitative suspension tests (EN 1040 and EN 1275), the growth of surviving bacteria and fungi in a nutrient broth was measured. The reduction factor in the suspension test without lactoperoxidase enzyme was < 1 for all three tested organisms. Thus, the mixtures of 2.0% (w/v; 0.34 M) thiocyanate and 0.4% (w/v; 0.12 M) hydrogen peroxide had no in vitro antimicrobial effect on Streptococcus mutans and sanguinis or Candida albicans. However, the suspension test with lactoperoxidase showed a high bactericidal and fungicidal effectiveness in vitro. CONCLUSION: The tested thiocyanate and H2O2 mixtures showed no relevant antimicrobial effect. However, by adding lactoperoxidase enzyme, the mixtures became not only an effective bactericidal (Streptococcus mutans and sanguinis) but also a fungicidal (Candida albicans) agent.

Improving adherence to surgical hand preparation.

At present, no universal agreement on detailed practice for surgical hand preparation exists. In order to fill this gap, in 2002 a Franco-German recommendation for surgical hand preparation was published as a first step towards a generally accepted European recommendation. Based on an assessment of the actual literature, a protocol for surgical hand preparation is discussed with the aim to recommend evidence-based standard procedures including prerequisites, washing and disinfection phase, and its practical implementation. In contrast to hygienic hand disinfection, for surgical hand preparation compliance is not an issue, since it mostly is regarded as a ceremony which is carried out without exception. Nevertheless, the following factors influence acceptance and efficacy: skin tolerance, ease of use, duration of procedure, and recommended time), potential for impaired efficacy due to incorrect performance of the procedure, possibility of systemic risks and irritating potential by applied preparations, religious restrictions, ecological aspects, costs and safety. Here, we report our experience with the introduction of a new hand preparation regime in all surgical disciplines in our university hospital based on the above factors. The following statements were evaluated: 1) The immediate efficacy of an alcohol-based hand disinfectant is impaired by a preceding hand wash for up to 10 minutes. Therefore hands should not be routinely washed before the disinfection period unless there is a good reason for it such as visible soiling. 2) A shortened application time (1.5 minutes) is equal to 3 min in terms of efficacy. 3) Hands should be air dried before gloves are put on, otherwise the perforation rate of gloves will increase. 4) The efficacy of alcohol-based disinfectants is significantly higher when hands are allowed to dry for 1 minute after the washing phase and before the disinfection phase. To clarify the above questions before the establishment of the modified technique, the surgical team was invited to a meeting. As a result, the heads of surgical departments supported the new technique and decided to change their practice.

Systemic iodine absorption after preoperative antisepsis using povidone-iodine in cataract surgery-- an open controlled study.

After preoperative conjunctival and periorbital antisepsis with povidone-iodine (PVP-I), the systemic absorption of iodine after cataract surgery was measured to evaluate the risk of thyroid side effects. Five different combinations of PVP-I alone or in combination with PVP-I-free antiseptics were applied to the conjunctiva and periorbital skin. An iodine-free product served as control. Iodide and creatinine in urine were analyzed before intervention and 24 and 48 h postoperatively. Depending on the concentration and application site, 0.3-4.5% of the total applied iodine or 3.6-45.4% of the free iodine were absorbed. The range of urine iodine excretion was between 11.7 and 71.0 mug iodine/g creatinine, depending on the PVP-I concentration and the site of application. The increase in iodine excretion was significant at 24 h postoperatively in trials receiving PVP-I both periorbitally and conjunctivally, depending of the concentration used. Because the iodine absorption is only slight and of doubtful clinical relevance, presurgical conjunctival antisepsis can be achieved with 1.25% PVP-I; so far clinically manifest anamnestic thyroid disorders are excluded. Presently, periorbital skin antisepsis with PVP-I cannot be recommended until data on thyroid metabolism in the population have been collected and evaluated, especially in a region currently or previously deficient in iodine.

The role of thiocyanate in the etiology of goiter in an industrial metropolitan area.

OBJECTIVE: Thiocyanate (SCN-) has concentration dependent antithyroid properties and a role in the etiology of goiter has been suggested in several studies. In 1991 an epidemiological survey conducted in the region of Halle/Leipzig (Saxony), an area with significant air pollution, suggested an inverse relationship between urinary iodine (I-)/SCN- excretion and goiter prevalence. 10 years later, we reinvestigated the same industrial area to clarify if the situation has changed after the elimination of most industrial waste products and moreover, if SCN- excretion levels alone or in combination with air pollution or smoking as a SCN- source are critical for thyroid function. DESIGN AND METHODS: We investigated a cohort of 708 probands for I-, SCN- and creatinine excretion in spot urine samples and determined the prevalence of goiter and thyroid nodules by high resolution ultrasonography. RESULTS: Probands with goiter (n = 79, 11%) had significantly higher urinary SCN- excretions than probands without (3.9 +/- 2.8 vs 3.1 +/- 3.4 mg SCN-/g creatinine) and significantly lower urinary I-/SCN- ratios than patients without thyroid disorders (41 +/- 38 vs 61 +/- 71 microg I-/mg SCN-/l). Mean urinary I- excretions were not different between probands with or without goiter. Smokers showed significantly elevated urinary SCN-/creatinine ratios in comparison to non-smokers (4.3 +/- 4.3 vs 2.4 +/- 2.1 mg SCN-/g creatinine). ANOVA revealed a prediction of thyroid volume through age (P < 0.001), gender (P < 0.001), body weight (P < 0.05) and smoking (P < 0.05). CONCLUSIONS: In our investigation, age, gender and smoking (raising SCN- levels by CN- inhalation) were predictive for thyroid volume and the urinary I-/SCN- ratios were able to detect probands with an increased risk of developing goiter in contrast to urinary I- excretion levels alone. These data suggest, that in an era and area of decreased cyanide pollution, SCN- may remain a cofactor in the multifactorial aetiology of goiter.

The influence of procarbazine and thiocyanate on embryonic bone maturation

The substance procarbazine (Natulan®) is a teratogen known to induce cleft palates in rats on day 14 post-conception. The application of thiocyanate (SCN-) alone to rats on day 10 and 14 of pregnancy had no effects on fetal bone maturation. However, when procarbazine was used, the maturation and growth of fetal bones was delayed. Upon additional application of thiocyanate, the effects of procarbazine (Natulan) were increased. Thus, no antiteratogenic effect of thiocyanate occurs. We propose that charge and metabolites of teratogenic agents play a key role in developing the effects of thiocyanate (AU)

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New aspects of the tolerance of the antiseptic povidone-iodine in different ex vivo models.

Investigating new possibilities for the application of 1% (v/v) iodophors, povidone-iodine (PVP-I) was better tolerated in the HET-CAM or explant test than 1% (w/v) silver nitrate or tetracycline. After application to the eye, at least 2.6% of used iodine were adsorbed. Therefore PVP-I is more effective than silver nitrate or erythromycin, meaning a possible alternative for the prevention of ophthalmia neonatorum. PVP-I is more active against methicillin-resistant Staphylococcus aureus (MRSA) in a human ex vivo skin model, which results in a complete eradication of S. aureus in the nasal cavity of volunteers after 2 daily applications and will be better tolerated by human nasal cilial epithelium than chlorhexidine. Having the same clinical tolerance as mupirocin, PVP-I is a useful alternative for the antiseptic therapy of germ carriers of MRSA. The synthesis of proteoglycans in articular cartilage of bovine sesamoid bones was increased after application of 5% (v/v) PVP-I without any increase in catabolism revealing possibilities for the use as irrigation solution in the joint.

[Postoperative opacification of 12 hydrogel foldable lenses (Hydroview(R))]. / Postoperative Kunstlinsen-Eintrübungen bei 12 Hydrogel-Intraokularlinsen (Hydroview(R)).

BACKGROUND: To evaluate postoperative lens opacifications in foldable hydrophilic intraocular lenses. PATIENTS AND METHODS: 12 patients (9 female; 3 male; mean age 77.5 +/- 3 years) were referred from one ophthalmologic surgeon because of opacification of IOLs and markedly decreased visual acuity. Time between implantation and explantation varied from 8 month to 3 years. IOL explantation was performed in all 12 patients and IOL were examined by light-, transmission- and scanning electron microscopy. RESULTS: IOL-explantation was uneventful in all 12 patients. The explanted IOLs showed crystalline deposits 0.5 to 2 microm in diameter immediately beneath the surface of the lens. Eight of 12 patients had elevated serum levels for glucose (6 patients with manifest diabetes mellitus, 2 patients with pathological elevated levels for glucose). CONCLUSIONS: Postoperative opacification of hydrogel foldable lenses (Hydroview(R)) are apperantly caused by formation of crystalline deposits beneath the lens surface. These deposits may be associated with metabolic disorders, e.g. diabetes mellitus.

[Urinary iodine levels within normal range in German school-age children]. / Jodidurie bei Schulkindern in Deutschland 1999 im Normbereich.

BACKGROUND: Recent regional investigations have shown that the abolition of the requirement to declare iodine in foodstuffs and the greater emphasis on information about goitre prevention led to an increase in urinary iodine excretion in Germany. There was also a decrease in thyroid size and goitre prevalence in children. No up to date results for the whole of Germany are available. PROBANDS AND METHODS: In 1999 we examined the urinary iodine excretion in the spontaneous morning urine of 3,065 healthy 6- to 12-year-old school children in 128 places from all over Germany. The iodine was measured by the Cer-arsenit method. RESULTS: The median iodine excretion amounted to 148 micrograms/l. There were no significant differences between age groups, sexes or regions. 73% had no iodine deficiency (> 100 micrograms/l). In 20% the deficiency was slight (50-99 micrograms/l), in 6% moderate (20-49 micrograms/l) and in 1% there was a severe iodine deficiency (< 20 micrograms/l). 8% excreted > 300 micrograms iodide per liter urine. CONCLUSION: According to the WHO guidelines, there is no longer a iodine deficiency in Germany--at least among children prior to puberty.