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Biomedical subjects

H Bürgi

Publications and source records attributed to H Bürgi.

At least 19 recordsLinked to original sources
PubMed1991

[Is iodination of cooking salt still necessary? Current studies on iodine supply in Switzerland].

Salt with 3.75 mg iodide per kg was introduced in Switzerland stepwise in the individual cantons between 1922 and 1952. The iodide content was raised to 7.5 mg in 1962 and to 15 mg per kg in 1980. 92% of retail salt and 78% of all salt for human consumption (including salt used in industrial food processing) was iodized in 1989. Under this measure, prevalence of grade 1b or larger goiter dropped continuously to a present value of 1.3% in school-children and 0.3% in male army recruits. Endemic cretinism has disappeared completely. Urinary iodine has reached the desired range of 150 +/- 77 (SD) micrograms per g creatinine. The following facts prove that iodization of salt (and not other changes of food habits) have corrected the iodine deficiency in Switzerland: 1. Urinary iodine is highly correlated with urinary sodium. Backward extrapolation yields a theoretical urinary iodine of 30 micrograms per g creatinine in the absence of iodized salt, a value typical of severe deficiency. 2. Goiter prevalence declined later in those cantons which introduced iodized salt last. 3. Surrounding countries without iodized salt (France, Italy, Federal Republic of Germany, Spain) suffer from considerable iodine deficiency with areas of high goiter prevalence and even endemic cretinism. The new data underscore the absolute and continued need for iodized salt in Switzerland.

Adolescent↗
PubMed1991

[Severe endocrine ophthalmopathy. A review with case reports].

The autoimmune pathogenesis of endocrine ophthalmopathy (EO) is only partly elucidated. About 40% of all patients with Graves' disease have clinically overt ophthalmopathy. 5% of all Graves' disease patients develop severe EO, independently of the treatment modality for thyrotoxicosis (radioiodine, surgery, antithyroid drugs) and require multidisciplinary treatment. In cases where glucocorticoid treatment is unsuccessful, orbital decompression, as described by Walsh and Ogura, should be considered.

Combined Modality Therapy↗
PubMed1991

Identification of a subgroup of Graves' disease patients at higher risk for severe ophthalmopathy after radioiodine.

We have analyzed retrospectively the records of 89 patients with Graves' disease who were treated with radioiodine between 1980-88 and whose ophthalmopathy was recorded in a uniform manner initially and after 5 and 12 months. Moreover information on progression of eye disease was obtained by telephone for all patients after an average of 72 months. Pretreatment endocrine ophthalmopathy (class greater than or equal to 1 of classification of American Thyroid Association) was present in 34% of the patients. Eight patients developed proptosis over 20 mm, 7 patients severe ophthalmopathy (classes 4 to 6), 5 patients required special treatment for eye disease. Among the 30 patients with initial ophthalmopathy, severe ophthalmopathy (5 of 30; p less than 0.05) and proptosis greater than 20 mm 16 of 30; p less than 0.05) developed in significantly more cases than in patients with no pretreatment ophthalmopathy. The data suggest that hyperthyroid patients with pretreatment ophthalmopathy are at risk for developing severe ophthalmopathy after 131I treatment.

Eye Diseases↗
PubMed1990

Iodine deficiency diseases in Switzerland one hundred years after Theodor Kocher's survey: a historical review with some new goitre prevalence data.

In certain regions of Switzerland, before prophylaxis, 0.5% of the inhabitants were cretins, almost 100% of schoolchildren had large goitres and up to 30% of young men were unfit for military service owing to a large goitre. Iodization of salt was introduced in 1922 at 3.75 mg I per kg and the iodine content was doubled twice, in 1962 and 1980, to the present 15 mg I per kg. In 1988, 92% of retail salt and 76% of all salt for human consumption (including food industry) was iodized, even though its use is voluntary. Urinary iodine excretion, previously between 18 and 64 micrograms per per day, has now risen to 150 micrograms per day. No new endemic cretins born after 1930 have been identified. Goitre disappeared rapidly in newborns and schoolchildren, more slowly in army recruits, and incompletely in elderly adults. In some Cantons (by constitution in charge of health matters and the salt monopoly) which allowed iodized salt only in 1952, disappearance of goitre lagged behind accordingly, proof that iodized salt was the cause of regression. The Swiss data provide evidence that isolated deafness, mental deficiency, and short stature, each without the other attributes of cretinism have also decreased. Adverse effects of iodized salt were minimal, possibly because the initial iodine content of salt was chosen very low. Iodization of salt has proved a highly cost-effective preventive measure in Switzerland.

Adult↗
PubMed1989

Iodine deficiency disorders in Europe.

Recent data on iodine excretion in the urine of adults, adolescents and newborns and on the iodine content of breast milk indicate a high prevalence of iodine deficiency (moderate in many cases and severe in a few) in many European countries. These cases may manifest as subclinical hypothyroidism in neonates and as goitre in adolescents and adults. Lack of iodine causes not only goitre, but also mental deficiency, hearing loss and other neurological impairments, and short stature due to thyroid insufficiency during fetal development and childhood. Although iodinated salt is available theoretically in most countries where it is needed, its quality and share of the market are often unsatisfactory. In many countries where only household salt is iodinated the iodine content has been set too low owing to an overestimation of household salt consumption. Governments are therefore urged to pass legislation and provide means for efficient iodination of salt wherever this is necessary.

Adolescent↗
PubMed1988

[Therapy of euthyroid goiter].

In regions of iodine deficiency TSH-suppressive therapy with L-thyroxine is quite successful: 50-60% of euthyroid goitres shrink (almost) totally and an additional 15-20% undergo a clinically useful reduction in size. 100 micrograms L-thyroxine daily suppresses TSH secretion in 75% of patients and 150 micrograms daily in 95%. Reduction of goitre size takes four to six months' treatment, which must be continued on a lifelong basis. In regions of sufficient iodine supply (such as Switzerland today) treatment of euthyroid goitre is less successful because TSH-independent factors (thyroid stimulating immunoglobulins and possibly other yet unknown growth factors) assume relatively greater importance. In Denmark, for example, L-thyroxine reduces the size of only about 50% of goitres by only about 20% of their sonographic volume. In nonendemic regions goitres generally are not only less prevalent but also of smaller size. The indication for surgery therefore more rarely arises from pressure symptoms or cosmetic reasons, but rather from concern over potential malignancy. Cytologic examination of fine-needle aspirates is the most important method of ruling out malignant lesions and is far more important than scintigraphy or sonography. The general consensus is that surgery should be advised in all cytologically suspect lesions, in addition, of course, to the frankly malignant lesions.

Biopsy↗
PubMed1988

Can serum thyroglobulin predict the effect of thyroid hormone therapy on goitre growth?

Serum thyroglobulin and goitre size were followed in 22 patients with simple goitre or single thyroid nodules during 9 months of thyroxine therapy, to see whether alterations in serum thyroglobulin correlated with changes in goitre size. In the case of such a correlation serum thyroglobulin could be used to predict which goitres respond to thyroxine therapy and which require surgery. Pretreatment serum thyroglobulin was elevated in 11 patients. It normalized in one of 7 patients whose goitre did not shrink and in none of the 4 patients whose goitre shrank during thyroxine treatment. Thus no simple correlation exists between alterations in serum thyroglobulin and goitre size during short-term thyroxine therapy. Since other studies suggest that increased serum thyroglobulin indicates ongoing goitre growth, thyroxine treatment might have been unsuccessful in all patients with persistently elevated serum thyroglobulin with a longer follow-up. The presence of predominantly thyroxine responsive tissue together with some autonomously growing, thyroglobulin-releasing areas in the same goitre could explain the failure of serum thyroglobulin to normalize in patients whose goitre shrank during therapy. The study shows that after eradication of iodine deficiency, thyroxine treatment is rarely successful in the Swiss goitre population and that surgical treatment is usually required.

Adult↗
PubMed1987

[New aspects in the surgical treatment of hyperparathyroidism].

As a result of routine serum calcium determinations an increasing number of primary hyperparathyroidism (pHPT) cases are detected. While surgical treatment of the symptomatic patient with pHPT is generally accepted, this may not be the case in asymptomatic and especially elderly patients. The value of preoperative localization of parathyroid tumors has not been clearly established. In our experience dual parathyroid imaging with thallium and technetium has provided the best results. With the growing number of dialyzed patients, secondary (sHPT) and tertiary hyperparathyroidism (tHPT) are assuming increasing importance. Patients suffering from symptomatic sHPT or tHPT should undergo parathyroid surgery. After respective follow-up of 3.8 years (pHPT) and 2 years (sHPT and tHPT), all the cases with pHPT showed a relevant fall in serum calcium levels and PTH.

Biopsy↗
PubMed1986

[Radioiodine therapy in hyperthyroidism: reliability of a long-term follow-up scheme for the diagnosis and treatment of hyperthyroidism based on the family physician and on a central registry].

We assessed the reliability of a follow-up scheme for radioiodine-treated patients which involved the general practitioner after the first year, leaving to the center only the operation of a central recall registry and the analysis of mailed blood samples and simple questionnaires. The analysis of 238 patients followed up for 3-6 years showed that the scheme was equal or superior to follow-up rates of published systems in Switzerland which rely on regular recalls of the patients to the center. However, the excellent follow-up rates published with similar systems in Great Britain were not quite achieved and efforts will be needed to diminish the number of patients lost to follow-up. Contrary to the experience of other authors, our laboratory results did not allow us to single out a group of patients with low likelihood of developing hypothyroidism and in whom follow-up examinations could be spaced at longer intervals. Reversing our current practice, we now recommend that hypothyroid patients be left on our registry once they are on replacement therapy with thyroxine. Examination of this patient group has revealed that 27% are undersubstituted, albeit only to a borderline degree in most cases.

Aged↗
PubMed1986

[The treatment of Basedow's disease. The agony of selection].

The treatment mode of Graves' disease should be chosen individually for each patient. This requires a thorough knowledge of the advantages and disadvantages of the various methods, and also bias-free interdisciplinary cooperation. Surgery reestablishes euthyroidism in about 80%, with 10% becoming hypothyroid. In centers practising more radical surgery hypothyroidism has developed in up to 49% and there is now evidence of occurrence of late hypothyroidism in the same way as after radioiodine. Radioiodine is cheap and causes minimal inconvenience to the patient. Because prevalence of hypothyroidism rises in a cumulative way over decades, lifelong follow-up is necessary with an examination every 1 to 2 years. The genetic risk and the danger of thyroid carcinoma have been shown to be negligible by gonadal dose calculations and by longterm prospective follow-up. Antithyroid drugs inhibit incorporation of iodide into thyroglobulin and produce rapid clinical improvement. It seems probable that, in longterm treatment, they also specifically suppress the synthesis of thyroid-stimulating immunoglobulins. The significance of "allergic" reactions such as skin rash, leukopenia and agranulocytosis is usually overestimated. The hematologic side effects are rare, dose-related and reversible in most cases. The major drawback of antithyroid drugs is the high recurrence rate (50%) of hyperthyroidism after cessation of therapy. It is still undecided whether a long course of treatment (one year or longer) produces better longterm results than short courses.

Antithyroid Agents↗
PubMed1979

[Experiences with an oral cocaine-morphine solution (Brompton mixture) in the treatment of severe pain in patients with neoplasms].

One year's experience is reported in the treatment of terminally ill cancer patients with an oral solution of morphine and cocaine on a fixed schedule. 36 consecutive patients were treated for an average of 51 days. Excellent or good pain relief was achieved with 26 patients (72%). The initial mean daily dose of morphine was 35 mg. After 12 weeks, the dose had to be raised to an average of 52 mg per day. Some patients received up to 180 mg morphine per day. Side effects were not uncommon but were without clinical consequences in most patients. Side effects caused discontinuation of treatment in only 2 patients. Terminally ill cancer patients often derive great benefit from this treatment.

Administration, Oral↗