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Seasonal variations in the frequency of thyrotoxicosis are known for a long time. Both, variations in the temperature and in the iodine supplementation are believed to affect the incidence of the diagnosis of hyperthyroidism. Seasonal variation of the incidence of hyperthyroidism was investigated before and after increase of salt iodination in 1990/1991. In the period from January 1987 to December 1995 hyperthyroidism was diagnosed for the first time on 4711 patients in our department. This population was subdivided according to etiology (Graves' disease, autonomous nodular goiter) and grade of hyperthyroidism (preclinical or clinical form). The so formed groups were divided according to the month of diagnosis into further 12 subgroups. Significant differences in month to month variation were found in the patients suffering from Graves' disease and autonomous nodular goiter with preclinical hyperthyroidism after increased iodine supplementation. The peak incidence of the diagnosis occurred in June, July, and August. Our results indicate that improved iodine supplementation may be the main cause of seasonal variations in the incidence of thyrotoxicosis.

Thyroid hormone autoantibodies may lead to abnormal values of free triiodothyronine (FT3) and free thyroxine (FT4) by interference with the radio immunoassay (RIA). We examined thyroid function in six patients with known triiodothyronine-binding autoantibodies using a RIA and an electro-chemiluminescence immunoassay (ECLIA). FT3 values measured by RIA were spuriously high, ECLIA measurement of FT3 led to correct values according to the patients' thyroid status. We conclude from these results that in patients with triiodothyronine-binding autoantibodies FT3 measurement by ECLIA is more useful than measurement by RIA.

The frequent occurrence of both rheumatoid arthritis and autoimmune thyroiditis was already investigated with in part many conflicting results. We investigated a number of 792 patients (383 of them suffering from rheumatoid arthritis and 409 with osteoarthritis). In all patients antithyroid peroxidase and antithyroglobulin antibodies were determined. Patients with rheumatoid arthritis showed a significantly higher occurrence of circulating thyroid antibodies than those with osteoarthritis (9.1% versus 3.7%, p = 0.0016). We conclude that there exists a cumulate coincidence of both diseases. Patients suffering from rheumatoid arthritis should undergo a thyroid examination especially for the presence of autoimmune thyroiditis.

Influences of non-steroidal anti-inflammatory drugs (NSAID) on concentrations of thyroid hormones are known for a long time. These effects could be explained with interference between NSAIDs and thyroid hormone binding. We investigated the effects of a single dose of aceclofenac on thyroid function and thyroid hormone binding in 18 healthy volunteers. Serum levels of free thyroid hormones (FT3, FT4) and thyrotropin (TSH) were measured with commercial available kids and thyroid hormone binding was estimated with a specially modified horizontal argarose-gel-electrophoresis prior to and 2 hours after receiving a single dose of aceclofenac. We found a significant decrease in T3 binding on TBG and a significant increase of albumin-bound T3. All other investigated thyroid hormone binding parameters, FT3 and FT4, showed no significant changes. We conclude that aceclofenac leads to a significant redistribution of T3 protein binding. These effects seem to be explained by T3 displacement from TBG induced by aceclofenac.

Effects of gender and age on quantitative sacroiliac joint imaging are discussed controversially. In most investigations the number of controls has been small and might not exactly reflect the change of sacroiliac/sacral (SI/S) ratios related to different age and gender. The aim of our study was to evaluate the changes SI/S ratios according to age and gender. In 125 patients without any history of either diseases or complaints of the sacroiliac joints a bone scintigraphy was obtained and the SI/S ratios were calculated. We observed a significant negative correlation of SI/S index with age. After separation into 4 different age groups a significant decline of the ratios could be shown. There were no significant differences between male and female patients. We conclude that the influence of age on SI/S ratios is substantial. But also many other factors like patient position, algorithm of SI/S ratio calculation, the time interval between application of the radiopharmaceutical and data acquisition may exert effects on SI/S ratios. It seems necessary for each department to evaluate their own age related reference values of SI/S ratios.

This study investigated the efficacy and safety of a diclofenac/orphenadrin infusion in 21 female and 1 male patients with clinically and radiologically diagnosed inflammatory osteoarthritis of the big joints, especially the knee and hip joints. The patients received 1 infusion per day over 2 h for 10 days. Efficacy and safety were assessed by measuring the subjective pain intensity at rest and during exercise on a visual analogue scale and on an ordinal rating scale before and after every infusion. The patients were interviewed daily for possible side effects. After the 10-days treatment course a 5% reduction of pain at rest and a 37.5% reduction of pain during exercise was observed. Subjective pain intensity was reduced by an average of 32.5%. In most cases relief was noticeable after the 4th infusion. 9 patients rated the medication safety as "very good", 11 patients as "good". A total of 12 patients reported mainly mild side effects such as vertigo, dry mouth, and temporarily reduced visual acuity. Based on its rapid onset of action and its efficacy, it can be stated that the investigated diclofenac/orphenadrin infusion is a valuable extension of the therapeutic methods in patients with inflammatory osteoarthritis.

Durch die Beschaffung neuer Höchstleistungsrechner - einer zukunftsträchtigen Kombination aus Vektor- und Parallelrechner - rücke Baden-Württemberg im Supercomputing an die europäische Spitze auf, so der offizielle Pressetext des Staatsministeriums Baden-Württemberg. Anläßlich des Vertragsabschlusses für den Kauf der Cray-Nachfolgerechner stellte Ministerpräsident Erwin Teufel auf der Landespressekonferenzam 30. Januar 1996 am RUS das Konzept der Landesregierung für das Bundesrechenzentrum und das Hochgeschwindigkeitsdatennetz vor. In dem neuen Zentrum seien Rechnungen höchster Komplexität in bisher nicht gekannter Geschwindigkeit möglich ...

The viscoelastic properties of hyaluronic acid solutions and synovial fluids were investigated by oscillating capillary rheology in a frequency range from 0.03 to 30 Hz. A clear dependency of these parameters, especially of the elastic component, on the molecular weight of the hyaluronic acid molecules was obtained. The addition of hyaluronic acid solutions to pathological synovial fluids improves the viscoelastic parameters depending on the applied dose. However, the rheological behavior of a "healthy synovial fluid" could not be reached by the procedure.

Am 12. September 1996 wurde das Bundes-Höchstleistungsrechenzentrum Stuttgart mit einem Festakt unter Beteiligung zahlreicher Vertreter aus Politik, Industrie und Wissenschaft eingeweiht. Aus diesem Anlaß fand am selben Tag ein wissenschaftliches Kolloquium über Stand und Perspektiven des Höchstleistungsrechnens statt. Der Ausbau des Rechenzentrumsder Universität Stuttgart zum Bundes-Höchstleistungsrechenzentrum, derzeit deine der europaweit leistungsfähigsten Einrichtungen des wissenschaftlichen Rechnens, stärkt nicht nur die Region Stuttgart und das Land Baden-Württemberg, sondern darf als wichtiger Beitrag für die künftige technologische und wirtschaftliche Entwicklung in Deutschland gewertet werden,sagte Wissenschaftsminister Dr. Klaus von Trotha anläßlich des Festaktes. Das HLRS steht sowohl Wissenschaftlern aus Universitäten und Forschungseinrichtungen als auch Partnern in der Industrie bundesweit zur Verfügung.

A 41-year old caucasian male presented with limited range of motion of the entire spine and myogenous intermittent claudication. He was referred with the diagnosis "ankylosing spondylitis". The clinical picture mimicked ankylosing spondylitis, but there were no corresponding radiological abnormalities despite a 13-year history of his disease. Laboratory values showed markedly elevated levels of muscle enzymes. The diagnosis of rigid spine syndrome, a subtype of muscular dystrophy, was made from the clinical picture a normal EMG and degenerative changes on a biopsy from the muscle trapezius. We would like to draw attention to this rare cause of back pain.

Disturbances of immunoglobulin production have often been observed in preclinical multiple myeloma and have led to the question of a pattern of reactive formation of monoclonal gammopathies. In the documented rare case of coincidental Ig-G-myeloma and rheumatoid arthritis some possible similar pathogenetic mechanisms in both diseases are discussed.

The case is presented of a female patient with rheumatoid arthritis, in whom a malignant non-Hodgkin lymphoma developed following long-term treatment with azathioprine. The possibility of an increased incidence of malignant lymphomas in immunological disorders, including rheumatoid arthritis, is discussed, as is the question of the extent to which azathioprine therapy might be involved in this. Some pathogenetic mechanisms of the development of malignant lymphomas are also considered.

The diabetic osteoarthropathy is an important diabetic complication. There is an obligatory connexion of the diabetic osteoarthropathy with the diabetic neuropathy. It seems to be essential for the diagnosis and treatment to separate the neuropathic and arthropathic lesions from angiopathic changes. It should be paid more attention to the diabetic osteoarthropathy in the treatment and training of diabetic patients suffering from diabetic neuropathy.

In 60 patients (48 cases were evaluated) with primary gout a longterm therapy (5--10 years) with Allopurinol was performed. Without treatment 4.4 sudden onsets of gout per patient and year were registrated; under Allopurinol only 0.062 (p less than 0.001) onsets were observed. This resulted in a large decrease in hospitalisation time from 44 days to 0.62 days per patient and year. In the majority of cases involution or diminuation of the tophi was found. In 7 cases of nephrolithiasis no further renal colic took place. In 8.3% a skin rasch and in 12.5% a slight gastrointestinal side effect was observed. Together with the clinical results the socio-medical aspects are discussed and the importance of gout in respect to the socioeconomic point of view is pointed out.

Some of the drugs, which are used in therapy of gout were tested with respect to their influence on semi-conservative DNA-synthesis and DNA-repair in vitro, using different cell systems. The agents (Benzbromarone, Allopurinol, Thiopurinol) were investigated in concentrations similar to blood-levels in normal therapy. The cells were irradiated with ultraviolet or ionizing radiation in order to damage their DNA and DNA-repair (unscheduled DNA-synthesis) was estimated by measuring the incorporation of radioactively labeled thymidine into acid insoluble material under appropriate conditions. The substances showed different effects on DNA-synthesis as well as on DNA-repair, even then, when their supposed influence on enzymes of nucleotide metabolism, was similar.

Among 167 in-patients with rheumatoid arthritis, 7 cases (4,2%) of diffuse interstitial pulmonary fibrosis of variable degree were revealed by chest X-ray examination. There was a predominance of the advanced functional classes according to Steinbrocker (where the duration of the disease was approximately the same as in patients without pulmonary fibrosis). There were higher 1-hour erythrocyte sedimentation rates and gamma-globulin valves and lower levels of hemoglobin and hematocrit in the patients with diffuse interstitial pulmonary fibrosis than in those without pulmonary changes. The etiological and pathogenetic aspects of several theories are discussed. The therapeutic possibilities are described and the importance of penicillamine therapy is emphasized.

Serum ferritin, transferrin and the stainable non-heme iron, were evaluated in 20 patients with rheumatoid arthritis in various stages and with different medications. We found a correlation between the serum ferritin values and the amount of stainable non-heme iron in the bone marrow, which was independent to the stage of the disease and the medication. The pathogenesis of the anemia in rheumatoid arthritis is discussed, together with the reported results in the literature.

The correlations of the serum levels of neopterin and beta-2-microglobulin with the disease activity-measured by a clinical index-were investigated in 41 patients suffering from rheumatoid arthritis. Both parameters correlated significantly with the sum of the used disease activity index. There was a closer correlation between the serum levels of beta-2-microglobulin and the sum of the index and most of the particular parameters of the index than it was seen for the neopterin serum levels.

The rheological properties of synovial fluids from patients with different rheumatic diseases are discussed. Viscosities of 73 samples were determined and are compared to a standard of "healthy" human synovial fluid p. m. and to bovine synovia. Typical differences between "healthy", degenerative and inflammatory synovial fluids could be discerned. These differences can be characterized with several rheological parameters. The mechanism of lubrication in joints and the role of synovial fluid as a lubricant are discussed. Rheological properties of polymere solutions which could serve as a substitute for sick synovial fluids are described and compared to the properties of healthy synovia. Several possibilities for molecular changes which could account for the deterioration of synovial fluids in patients with different rheumatic diseases are discussed.

The viscosity of "normal" post mortem synovial fluid, and synovial fluid samples of knee joints affected by various joint diseases (inflammatory and non inflammatory) was investigated and compared with flow curves of Hyaluronic acid and Polyacrylamide solutions. The viscoelastic behaviours of synovial fluid seems to be of great importance for the lubrication mechanism of the joints. Differing results of the viscoelastic properties could be determined in different joint diseases. As a result of these changes the lubrication mechanism is impaired and this leads to cartilage wear. Solutions of Polyacrylamide and Hyaluronic acid have been investigated as model-substances, the former showing rheological properties similar to normal synovial fluid. Their application as an artificial lubricant has been investigated.

The study comprises 79 patients with rheumatoid arthritis and their death rate and causes of death in comparison to an age- and sex-matched conrol group. The patients had died in the years from 1952 till 1977 and an autopsy was done on all of them in the University Institute of Pathology. Infections turned out to be the most common cause of death (48%), second in rank were various cardiac diseases (20%) while the percentage of other causes of death never exceeded 10 per cent. Possible relations between infections and their importance as a cause of death are discussed.

In about 20 to 30% of patients receiving intramuscular gold salts untoward side-effects of variable severity are known to occur with resultant discontinuation of treatment in a high percentage of cases to be on the safe side. Among the most common, albeit harmless side-effects are those affecting the skin and the mucous membranes. These are followed by renal symptoms. Grave complications affecting the hemopoietic system (leucopenia, thrombocytopenia, aplastic anaemia) are rarely seen. Other potential side effects (pulmonary fibrosis, liver damage, neuropathies, vasomotor reactions, loss of hair, nail changes) are extremely uncommon or no more than anecdotal). Meticulous follow-ups at regular intervals are imperative to minimize the associated risks.

272 patients with various rheumatic disorders were interviewed on the basis of a 28 points questionnaire concerning a possible self-medication with non prescribed remedies. A total of 272 patients (78%) had taken various non prescribed remedies and additionally 56 patients had kept self-made dietary restrictions. The parameters favouring an increased rate of self-medication were: female sex, increased age and a prolonged duration of the disease. However, the type of the rheumatic disorder did not play any significant role. The possible reasons of this high degree of self-medication with non prescribed remedies are discussed and improved patient-information by the physician is postulated.