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Introduction Established scores estimate 10-year fracture risk in osteoporosis to assist with treatment recommendations. This study compared the risk probabilities of major osteoporotic and hip fractures calculated by the FRAX tool with those of the DVO score, established in German-speaking countries. Material and Methods This seven-year retrospective study analyzed data of 125 male patients (mean age: 59.2±10.7 years) evaluated for osteoporosis. For the DVO score, the therapy threshold of>30% for vertebral and hip fractures suggested by DVO guidelines was implemented. We calculated fracture risks based on FRAX scores with aBMD and applied a common therapy threshold of≥3% for hip fracture and subsequently determined the “DVO-equivalent risk level” for FRAX-based assessment that would identify as many male patients as identified by the DVO score. Results Based on DVO score, 60.0% of patients had a 10-year risk of hip and vertebral fractures>30%. The recommendations for individuals based on FRAX scores for hip fracture with aBMD with risk≥3% overlapped with those based on DVO score in 36% of patients. Patients identified for treatment only by DVO score presented a higher percentage of spine fractures (65 vs. 41%). The thresholds for this “DVO-equivalent risk level” for ‘FRAX with aBMD’ was estimated to be≥6.7% for major osteoporotic fracture and≥2.1% for hip fracture.This study demonstrates that the DVO score was more sensitive than the FRAX score for patients with prevalent spinal fractures. We suggest considering the appropriate score and therapy threshold carefully in the daily care of male patients.

Thyroid hormones are key regulators of skeletal development in childhood and bone homeostasis in adulthood, and thyroid diseases have been associated with increased osteoporotic fractures. Hypothyroidism in children leads to an impaired skeletal maturation and mineralization, but an adequate and timely substitution with thyroid hormones stimulates bone growth. Conversely, hyperthyroidism at a young age accelerates skeletal development, but may also cause short stature because of a premature fusion of the growth plates. Hypothyroidism in adults causes an increase in the duration of the remodeling cycle and, thus, leads to low bone turnover and enhanced mineralization, but an association with a higher fracture risk is less well established. In adults, a surplus of thyroid hormones enhances bone turnover, mostly due to an increased bone resorption driven by osteoclasts. Thus, hyperthyroidism is a well-recognized cause of high-bone turnover secondary osteoporosis, resulting in an increased susceptibility to fragility fractures. Subclinical hyperthyroidism, especially resulting from endogenous disease, also has an adverse effect on bone mineral density and is associated with fractures. In most patients with overt or subclinical hyperthyroidism restoration of the euthyroid status reverses bone loss. In postmenopausal women who receive thyroid-stimulating hormone suppression therapy because of thyroid cancer, antiresorptive treatments may be indicated. Overall, extensive data support the importance of a euthyroid status for bone mineral accrual and growth in childhood as well as maintenance of bone health in adulthood.

Die Anforderungen fur eine 25-OH-Vitamin-D-Messung nahmen in den letzten Jahren deutlich zu. Auf Basis der nationalen und internationalen Literatur zu diesem Thema werden die Qualitat der Messmethode untersucht und die Problematik der Vitaminmessung an Beispielen dargestellt. Der Vitamin-D-Metabolismus und die Besonderheiten der Vitamin-D-Messung werden besprochen sowie eine Stellungnahme zur Indikation und eine Ubersicht uber die Therapieempfehlungen gegeben. Aufgrund der Zunahme der Anforderungen fur eine 25-OH-Vitamin-D-Messung wurde vom international verwendeten DiaSorin-Assay auf automatisierte Messsysteme umgestellt. Vergleichende Messungen ergaben bei Verwendung des DiaSorin-Assays niedrigere Werte als bei den chromatografischen Methoden. Dies verstarkte die internationalen Bemuhungen um eine Standardisierung deutlich. Aktuell wird die massenspektrometrische LC-MS/MS (LC: „liquid chromatography“, MS: Massenspektrometrie) als Methode der Wahl angesehen, ist aber mit Immunoassays und dem DiaSorin-Assay, abhangig vom jeweiligen Laboratorium, nicht vergleichbar, wenn nicht dieselben Standards zur Kalibrierung verwendet werden. An dieser Problematik wird international intensiv gearbeitet, und es werden Standards entwickelt. Bis zu deren Etablierung muss von Variationen zwischen den Messsystemen von mindestens 35 % gerechnet werden. Bei der immer noch teuren Methode ist die Messung nur bei bestimmten Risikopersonen, nicht aber der Gesamtbevolkerung indiziert. Die Messergebnisse werden in der Regel im Zusammenhang mit anderen Parametern des Kalziumstoffwechsels beurteilt. Eine Kontrolle nach Supplementierung sollte erst nach 3–4 Monaten erfolgen, wenn irgend moglich mit der gleichen Messmethode.

ZusammenfassungDieser Fallbericht handelt von einer 75-jährigen Patientin, die wegen einer Lungenerkrankung mit inhalativen und oralen Glukokortikoiden behandelt wird. Es wurde keine parallele spezifische antiosteoporotische Therapie mit Beginn der Glukokortikoidtherapie vom Hausarzt oder dem betreuenden Pulmonologen eingeleitet. Eine Therapie mit einem Bisphosphonat wurde bei Auftreten von Wirbelkörperfrakturen von orthopädischer Seite begonnen. Unter der Therapie mit Alendronsäure, Vitamin D und Kalzium traten neue Wirbelkörperfrakturen auf. Mit der in der Folge durchgeführten weiteren Abklärung bezüglich einer sekundären Osteoporose konnte eine zusätzliche Ursache für eine Verschlechterung der Knochensituation gefunden werden. Im weiteren Verlauf wurde die Medikation zweimal umgestellt und die Risikofaktoren reduziert. Die Patientin blieb unter dieser Therapie bis zum aktuellen Zeitpunkt ohne weitere Fraktur.

Thyroid hormones are key regulators of skeletal development in childhood and bone homeostasis in adulthood, and thyroid diseases have been associated with increased osteoporotic fractures. Hypothyroidism in children leads to an impaired skeletal maturation and mineralization, but an adequate and timely substitution with thyroid hormones stimulates bone growth. Conversely, hyperthyroidism at a young age accelerates skeletal development, but may also cause short stature because of a premature fusion of the growth plates. Hypothyroidism in adults causes an increase in the duration of the remodeling cycle and, thus, leads to low bone turnover and enhanced mineralization, but an association with a higher fracture risk is less well established. In adults, a surplus of thyroid hormones enhances bone turnover, mostly due to an increased bone resorption driven by osteoclasts. Thus, hyperthyroidism is a well-recognized cause of high-bone turnover secondary osteoporosis, resulting in an increased susceptibility to fragility fractures. Subclinical hyperthyroidism, especially resulting from endogenous disease, also has an adverse effect on bone mineral density and is associated with fractures. In most patients with overt or subclinical hyperthyroidism restoration of the euthyroid status reverses bone loss. In postmenopausal women who receive thyroid-stimulating hormone suppression therapy because of thyroid cancer, antiresorptive treatments may be indicated. Overall, extensive data support the importance of a euthyroid status for bone mineral accrual and growth in childhood as well as maintenance of bone health in adulthood.

Die Osteoporose ist eine systemische Skeletterkrankung, die durch eine unzureichende Knochenfestigkeit zu einem erhohten Frakturrisiko fuhrt, mit allen daraus resultierenden korperlichen und psychosozialen Folgen. Bei der Abklarung von sekundaren Osteoporosen findet sich in 5,6–6,4% der Falle eine Schilddrusenfunktionsstorung als Ursache. Eine Hyperthyreose ist ein Risikofaktor fur eine erniedrigte Knochendichte und osteoporotische Frakturen unabhangig von Alter und Geschlecht. Dabei spielt die direkte Wirkung der Schilddrusenhormone und des TSH auf den Knochen uber eine Steigerung der Knochenresorption ebenso eine Rolle wie systemische Veranderungen des Vitamin-D- und Kalziumstoffwechsels mit einem Kalziumverlust uber die Niere. Effekte der Hyperthyreose auf Muskel und Herz sind an einem erhohten Sturzrisiko mit Frakturfolge beteiligt. Die Therapie der Hyperthyreose beseitigt das Risiko fur Frakturen und kann die Knochendichte nahezu normalisieren. Vitamin D und/oder Bisphosphonate verbessern ebenfalls die Knochendichte in dieser Situation. Eine subklinische Hyperthyreose wird bei bis zu 24% der > 60-jahrigen beschrieben und erhoht das Frakturrisiko, vor allem bei postmenopausalen Frauen. Pramenopausale Frauen sind davon nicht betroffen, bei Mannern gibt es Hinweise fur ein erhohtes Huftfrakturrisiko. Bezuglich der Therapie mit Schilddrusenhormonen sollten somit die TSH-Werte bei postmenopausalen Frauen moglichst nicht supprimiert sein. Bereits bei TSH-Werten 60 Jahre und Manner > 70 Jahre ist allein mit diesem Wert das 10-Jahres-Gesamtfrakturrisiko > 20% und damit die Indikation fur eine Knochendichtemessung gegeben. Diese Patienten scheinen von einer Kalziumgabe zu profitieren und sprechen gut auf eine Bisphosphonattherapie an.

ZusammenfassungDie vorliegende Publikation ist mit dem Ziel erstellt worden, den engen Zusammenhang zwischen chronisch entzündlichen Darmerkrankungen (CED) und dem gleichzeitig häufigen Auftreten einer Osteopenie bzw. Osteoporose darzustellen. Hierbei ist das Aufzeigen multipler Risikofaktoren bei CED für eine Knochendichteminderung wie auch für das hiermit verknüpfte deutlich erhöhte Frakturrisiko ein wichtiges Anliegen. Wege der Prävention osteoporosebedingter Frakturen wie auch das mögliche Therapiespektrum einer Osteoporosebehandlung werden aufgezeigt. Dies ist umso wichtiger, als es sich bei CED-Patienten häufig um junge Patienten handelt, die bereits früh beispielsweise Wirbelkörperfrakturen erleiden können. Neben dem Therapieregime „Meidung einer systemischen Kortikoidtherapie“ zur Remissionserhaltung bei CED kann der frühe Einsatz z. B. von Azathioprin wie auch Anti-TNF-alpha-Therapien nicht nur nachhaltig die Remission bei CED unterstützen, sondern bei gegebenem Zusammenhang erhöhter Zytokinprofile und Frakturrisiko einer Knochendichteminderung erfolgreich entgegenwirken. Das entsprechende therapeutische Vorgehen wird nachfolgend beschrieben.

Increased serum concentrations of the aminoterminal propeptide of collagen III (PIIINP) are found in overt hyperthyroidism. Thus, measurement of serum PIIINP might be useful as an early marker of tissue hyperthyroidism in patients with TSH suppressive thyroxine treatment. In a prospective study we evaluated female patients followed in the thyroid outpatient clinic. Serum PIIINP concentrations were analysed in three groups: patients with TSH suppressive thyroxine treatment for more than 6 months (n = 33, TSH < 0.1 mU/l), patients with thyroxine substitution for hypothyroidism for more than 6 months (n = 20, TSH 0.2-4.0 mU/l) and spontaneous hyperthyroid patients (n = 8, TSH < 0.03 mU/l, increased freeT4 and/or T3). Beside TSH, thyroid hormones and serum PIIINP we measured serum SHBG and a clinical score. Hyperthyroid patients had clearly elevated serum PIIINP and SHBG values and a higher clinical score when compared with other study groups (p < 0.001). Patients with TSH suppressive thyroxine treatment had higher fT4 and T3 concentrations than the thyroxine substitution group (fT4 22 +/- 4.8 pmol/l vs. 17 +/- 2.6 pmol/l, T3 2.2 +/- 0.4 nmol/l vs. 1.8 +/- 0.3 nmol/l, p < 0.001) and also elevated serum SHBG values (77.6 +/- 27.5 nmol/l vs. 58.4 +/- 18 nmol/l, p < 0.01). However, serum PIIINP concentrations and the clinical score were very similar in both thyroxine treated groups (PIIINP in TSH suppression group 3.0 +/- 0.67 microg/l vs. 2.8 +/- 0.65 microg/l in the substitution group, clinical score 2 +/- 1.8 pts. vs. 1.7 +/- 1.5 pts. p = n.s.). In conclusion, serum PIIINP is not a reliable early marker for detection of tissue hyperthyroidism in long-term thyroxine treated women with suppressed TSH.

HISTORY AND CLINICAL FINDINGS A 46-year-old woman was referred to the neurosurgery department for treatment of a macroadenoma of the pituitary. She had complained of recurrent galactorrhoea for 7 years; a hysterectomy was performed 4 years ago. The clinical investigation was unremarkable, except for a slight galactorrheoa on both sides. INVESTIGATIONS The endocrinological work-up revealed a moderately elevated prolactin level of 3133 mU/l (147 ng/ml) with intact pituitary functions. She had no visual impairment and the MRI depicted a pituitary tumor with a maximal diameter of 1.9 cm and both intra- and suprasellar extension. DIAGNOSIS, TREATMENT AND CLINICAL COURSE The diagnosis of a nonfunctioning macrodenoma with functional hyperprolactinemia was made and a selective transsphenoidal adenomectomy was performed. The primary histology showed a chromophobe adenoma. However, additional immunohistological investigations revealed distinct staining for prolactin. In the meantime, because of persistent galactorrhea and elevated prolactin levels, treatment with cabergolin 0.5 mg/week was started. This stopped galactorrhea and normalized the prolactin levels. A follow-up MRI after 3 months of treatment showed a significant shrinkage of the residual tumor. CONCLUSION This case demonstrates that the differential diagnosis of macroprolactinoma with low secretory activity and functional hyperprolactinemia is very difficult preoperatively in individual cases. This is relevant because macroprolactinomas with low secretory activity can also be treated successfully with dopamine agonists. We therefore suggest a drug treatment trial with dopamine agonists in all macroadenoms with hyperprolactinemia, particularly in those with prolactin levels above 2000 mU/l (100 ng/ml).

Periprosthetic osteolysis is a major cause of aseptic loosening in artificial joint replacement. It is assumed to occur in conjunction with the activation of macrophages. We have shown in vitro that human osteoblast-like cells, isolated from bone specimens obtained from patients undergoing hip replacement, phagocytose fine particles of titanium alloy (TiAlV). The human osteoblast-like cells were identified immunocytochemically by the presence of bone-specific alkaline phosphatase (BAP). With increasing duration of culture, a variable number of the osteoblastic cells became positive for the macrophage marker CD68, independent of the phagocytosis of particles, with a fine granular cytoplasmic staining which was coexpressed with BAP as revealed by immunodoublestaining. The metal particles were not toxic to the osteoblastic cells since even in culture for up to four weeks massively laden cells were vital and had a characteristic morphology. Cells of the human osteosarcoma cell line (HOS 58) were also able to phagocytose metal particles but had only a low expression of the CD68 antigen. Fluorescence-activated cell scanning confirmed our immunocytochemical results. Additionally, the cells were found to be negative for the major histocompatibility complex-II (MHC-II) which is a marker for macrophages and other antigen-presenting cells. Negative results of histochemical tests for tartrate-resistant acid phosphatase excluded the contamination by osteoclasts or macrophages in culture. Our observations suggest that the osteoblast can either change to a phagocytosing cell or that the phagocytosis is an underestimated property of the osteoblast. The detection of the CD68 antigen is insufficient to prove the monocytic lineage. In order to discriminate between macrophages and osteoblasts additional markers should be used. To our knowledge, this is the first demonstration of cells of an osteoblastic origin which have acquired a mixed phenotype of both osteoblasts and macrophages.

SummaryThe prevalence of cervical lymphadenopathy in autoimmune thyroiditis (AIT) patients is actually unknown. The aim of the study was the detailed retrospective evaluation of 6 index-patients with lymphadenopathy in Robbins level VI and a prospective study with high resolution ultrasound of lymphadenopathy in AIT patients compared with controls in all compartments of the neck, accessible to sonographic evaluation. Patients, methods: The retrospective study comprises six patients with AIT, evaluated for enlarged Robbins level VI-LN. We report the findings of fine-needle aspiration Cytology, clonal analysis, histology, and serological testing. The prospective study evaluated the prevalence of lymphadenopathy in 49 consecutive patients with AIT (group 1) and 49 consecutive patients with normal thyroids or nontoxic goiter (group2). Results: In the retrospective study, cytology of paratracheal LN revealed reactive lymphoid hyperplasia in 5/6 of the cases and a centroblastic lymphoma in one patient. The presence of monoclonal lymphatic cells was excluded in 5/6 patients and proven in 1/6 patients. Actual viral-infections were ruled out. In the prospective study AIT-patients showed significantly more enlarged LN in Robbins level II-IV and VI compared to controls. We found no correlation between lymphadenopathy, age, thyroid volume and nodularity, or autoantibody levels. During follow-up in 34 group 1-patients, lymph adenopathy remained stable in 28 patients, and decreased in 6 patients. Conclusion: Lymph adenopathy in Robbins level II-IV and VI is common in AIT-patients and most probably related to the autoimmune process.

A 46-year-old woman was referred to the neurosurgery department for treatment of a macroadenoma of the pituitary. She had complained of recurrent galactorrhoea for 7 years; a hysterectomy was performed 4 years ago. The clinical investigation was unremarkable, except for a slight galactorrheoa on both sides.The endocrinological work-up revealed a moderately elevated prolactin level of 3133 mU/l (147 ng/ml) with intact pituitary functions. She had no visual impairment and the MRI depicted a pituitary tumor with a maximal diameter of 1.9 cm and both intra- and suprasellar extension.The diagnosis of a nonfunctioning macrodenoma with functional hyperprolactinemia was made and a selective transsphenoidal adenomectomy was performed. The primary histology showed a chromophobe adenoma. However, additional immunohistological investigations revealed distinct staining for prolactin. In the meantime, because of persistent galactorrhea and elevated prolactin levels, treatment with cabergolin 0.5 mg/week was started. This stopped galactorrhea and normalized the prolactin levels. A follow-up MRI after 3 months of treatment showed a significant shrinkage of the residual tumor.This case demonstrates that the differential diagnosis of macroprolactinoma with low secretory activity and functional hyperprolactinemia is very difficult preoperatively in individual cases. This is relevant because macroprolactinomas with low secretory activity can also be treated successfully with dopamine agonists. We therefore suggest a drug treatment trial with dopamine agonists in all macroadenoms with hyperprolactinemia, particularly in those with prolactin levels above 2000 mU/l (100 ng/ml).

Periprosthetic osteolysis is a major cause of aseptic loosening in artificial joint replacement. It is assumed to occur in conjunction with the activation of macrophages. We have shown in vitro that human osteoblast-like cells, isolated from bone specimens obtained from patients undergoing hip replacement, phagocytose fine particles of titanium alloy (TiAlV). The human osteoblast-like cells were identified immunocytochemically by the presence of bone-specific alkaline phosphatase (BAP). With increasing duration of culture, a variable number of the osteoblastic cells became positive for the macrophage marker CD68, independent of the phagocytosis of particles, with a fine granular cytoplasmic staining which was coexpressed with BAP as revealed by immunodoublestaining. The metal particles were not toxic to the osteoblastic cells since even in culture for up to four weeks massively laden cells were vital and had a characteristic morphology. Cells of the human osteosarcoma cell line (HOS 58) were also able to phagocytose metal particles but had only a low expression of the CD68 antigen. Fluorescence-activated cell scanning confirmed our immunocytochemical results. Additionally, the cells were found to be negative for the major histocompatibility complex-II (MHC-II) which is a marker for macrophages and other antigen-presenting cells. Negative results of histochemical tests for tartrate-resistant acid phosphatase excluded the contamination by osteoclasts or macrophages in culture. Our observations suggest that the osteoblast can either change to a phagocytosing cell or that the phagocytosis is an underestimated property of the osteoblast. The detection of the CD68 antigen is insufficient to prove the monocytic lineage. In order to discriminate between macrophages and osteoblasts additional markers should be used. To our knowledge, this is the first demonstration of cells of an osteoblastic origin which have acquired a mixed phenotype of both osteoblasts and macrophages.

Parathyroid Hormone-related Protein (PTHrP), ein funktionelles Analogon zum Parathormon, ist in 63% der primaren Mammakarzinome [1] and in 92% der ossaren Mammakarzinom-Metastasen nachweisbar [2]. Bisherige Untersuchungen zeigten, das der Grad der PTHrP-Expression mit der Inzidenz ossarer Filialisierung korrelierte [3]. In einer prospektiven Studie [4] wurde zum Nachweis minimaler Tumorzelldissemination mittels Reverse-Transkription/Polymerase-Kettenreaktion(RT/PCR)-Technik bei n = 71 primaren Mammakarzinom-Patientinnen (Pat.) das PTHrP im Knochenmark (KM) und im peripheren Blut (PB) untersucht. Im Nachbeobachtungszeitraum von 27 Monaten (Median) bestatigte sich bei 7/17 Pat. mit initial positivem PTHrP-Nachweis im PB and/oder KM das potentiell erhohte Rezidivrisiko durch das Auftreten von 4 lokalen and 3 ossaren Rezidiven. Aufgrund der Ergebnisse dieser fortgesetzten Studie sollte in zellbiologischen Untersuchungen am Tumorgewebe von Pat. mit einem primaren Mammakarzinom, an Tumorzell-Linien, im KM-Mikromilieu and an CD34+ hamatopoetischen Vorlauferzellen aus PB geklart werden, ob PTHrP ein fur die Tumorzellproliferation verantwortlicher autokriner/parakriner Wachstumsfaktor ist.

Altere Menschen haben zunehmend Probleme, ihre Vitamin-D-Versorgung uber die naturlichen Mechanismen aufrechtzuerhalten. Vor allem Patienten in Pflegeheimen zeigen meist einen gravierenden Vitamin-D-Mangel. Aufgrund des generell bestehenden relativen Defizits fur dieses Vitamin in der Bevolkerung erscheint eine generelle Substitution der uber 70-jahrigen Patienten angebracht.

1Alpha,25-dihydroxyvitamin D3 (1,25-(OH)2D3) is a potent mediator of differentiation and maintenance of specific functions of osteoblasts. To detect novel targets for 1,25-(OH)2D3 action, we applied differential display PCR to human fetal osteoblast-like cells and identified the human analog of murine cystein rich protein 61 (hCYR61) as a 1,25-(OH)2D3-responsive immediate early gene in differentiated fetal osteoblast-like cells. The murine gene CYR61 is important for cell-cell and cell-matrix interactions, and it belongs to an emerging gene family of cysteine-rich proteins. hCYR61 messenger RNA (mRNA) steady-state levels were stimulated 11-fold by 10 nM 1,25-(OH)2D3 by 1 h and declined to control levels by 4 h. This transient stimulation of hCYR61 mRNA was not inhibited by cycloheximide but was prevented by actinomycin D, indicating that the 1,25-(OH)2D3 effect involves transcriptional events and does not require de novo protein synthesis. hCYR61 mRNA stability was not influenced by 1,25(OH)2D3, whereas cycloheximide treatment stabilized hCYR61 mRNA. FCS, as well as growth factors and cytokines such as basic fibroblast growth factor, epidermal growth factor, tumor necrosis factor alpha, and interleukin-1, strongly elevated hCYR61 mRNA steady-state levels within 1 h. hCYR61 mRNA was expressed also in primary human osteoblasts and osteosarcoma cell lines. Using a commercial tissue blot, hCYR61 mRNA was only observed in skeletal muscle. The fast and transient response of hCYR 61 to 1,25-(OH)2D3, serum, growth factors, and cytokines suggests an important role of hCYR61 for osteoblast function and differentiation.

Dizygotic twin sisters were born to a woman who, shortly before becoming pregnant, had developed Graves' disease with markedly elevated triiodothyronine (T3) levels and highly positive TSH receptor antibody titres (TRAb: 169 mU/ml). From the second week of life onwards they had a goitre and hyperexcitability, tachycardia and failure to thrive were noted. In addition, twin I had mild exophthalmos. As thyrostatic treatment of the mother was very difficult, intrauterine hypothyroidism or transitory hyperthyroidism had presumably occurred in the twins.Twin I had maximal thyroxine (T4) concentration of 26.2 micrograms/dl, while it was 24.7 micrograms/dl in twin II with suppressed TSH. Both twins had high concentrations of TRAb and antibodies against thyroid peroxidase.With the diagnosis of neonatal Graves' disease established, both twins were treated with propranolol (2 mg/kg.d) and phenobarbitone (2-4 mg/kg.d). Twin I, whose symptoms were more severe, also received propylthiouracil (5 mg/kg.d) until euthyroidism had been achieved. Although twin II became euthyroid spontaneously, she gained weight only slowly and microcephaly developed together with definite motor and mental retardation. It remains unclear whether these were consequences of intrauterine hypothyroidism or post-partum hyperthyroidism.Graves' disease during pregnancy demands interdisciplinary collaboration between gynaecologist, physician and paediatrician to prevent severe sequelae in the children. Early risk assessment is possible by measuring the TSH receptor antibody titre in umbilical blood.

The influence of a 6 weekly physical training of the performance in patients of the age between 60 and 70 years who have had a definitive myocardial infarction has been tested in phase II or rehability. Dayly in patient and under physicinal control the conditioning were executed in the time of 30 minutes on a bicycle--hometrainer. The personal intensity of training was choosed so that anwunted to 60--70% of heart-frequency obtained by the maximal exercise. Additional a terrain-training was taken part. Under conditioning a different relation of performance was recognized by patients (12 patients--performance decreased, 15 patients--constant performance, 33 patients--performance increased). To prevent a negative development of physical performance the result of performance--pulse (N/Hf) should be observe especially.

In his leisure time man is ridden from social requirements. The leisure time has in the single periods of life different problems and figurations. It is a part of life-span and is formed by the individuality and by the society. Labour and leisure time are not in contrast to each other, they involve one another. Our study of leisure time of older people (n = 245) let notice that 7% live more or less isolated, 64% are middling or much engaged by homework, and 30% take always care of relatives. The chance of a subjective contentment in life in all the more since the own activity is more extensive. It contains the orientation about the future with desires and plans.