The authors describe the diagnostic algorithm of Zollinger-Ellison's syndrome which proved useful in the diagnosis of 73 patients with a confirmed diagnosis. They evaluate the diagnostic validity of anamnestic and clinical data, of different examination methods and compare them with experience assembled abroad. For the diagnosis of sporadic gastrinomas the onset of the disease after the age of 40 years is important, the development of serious peptic complications (haemorrhage F-70%, M-59%, perforation M-54%, F-47%) and the presence of watery diarrhoea (41%). As to laboratory parameters they rely on high BAO values (96% > 15 mmol H+/hour and 100% > 5 mmol H+ after gastric resection. Less important is the examination of basal serum gastrin (almost 30% patients have normal or liminal values of BSG--empirically set at 100-150 pg. ml-1). The authors draw attention to the fact that patients with ZES after gastric resections may have BSG values lower than 100 pg/ml (12%). A positive secretin test has a higher validity (rise of SG by 150-200 pg. ml-1 above basal values) positive in 82.2% patients, liminally positive in 11% and negative in 6.3% patients. An even higher diagnostic value was possessed by a BAO/MAO index higher than 0.6 which was positive in 93.4% patients. At present it is not used as pentagastrin is not available. Every year they diagnose 4-6 new cases of ZES which with regard to the number of inhabitants (5 million) places Slovakia along with Denmark and Sweden among the countries with the highest detection rate (0.8-1.2 ZES cases/1 million per year).
The results of the survey show that as a consequence of the nuclear accident in Chernobyl contamination of foodstuffs with radioactive substances caused in May 1986 and additional irradiation of the population of the West Slovakian region which amounted to approximately 10-20% of the dose load derived from natural sources (cosmic radiation, radioactive substances present in the earth crust, in building materials, etc.). The mean dose load of the population was roughly 8 times higher in 1986 than in 1965, when tests of nuclear weapons had been carried out in the atmosphere and when systematic monitoring of radioactivity in foodstuffs had been implemented in the West Slovakian region. Contamination of the environment due to nuclear weapon tests reached the highest values in 1962-1963 when the dose load of the population can be assumed to have been 2-3 times higher than in 1965. In the locality of the nuclear power plant Jasl. Bohunice contamination of foodstuffs with radioactive substances was in the period of operation of the plant at the level of foodstuff contamination recorded at the reference site.
Due to successful progress in monitored iodine prophylaxis of iodine deficiency during the last decades the prevalence of endemic goitre in several countries considerably decreased. Nevertheless, epidemiological studies have been also indicating a certain prevalence of small thyroids in the areas of iodine deficiency too, and, vice versa, that even after successful iodine prophylaxis the thyroid volume (ThV) is not equally decreasing in all subjects and goitre does still exist. This phenomenom has been called sporadic goitre and hereditary etiological factors were suspected. It is shown that after 40 years of successfully monitored and mandatory consumption of iodized salt in Slovakia the distribution of ThV in 2661 adults has considerably decreased as compared to that of 1380 adults from Germany and Denmark where median iodine deficiency was still present around 1990. However, in spite of that, in those 2661 adults from Slovakia the average ThV in the upper quartile was 22.5 ml which was 4-times higher than the value in the lower quartile (6.3 ml) or about twice as much as that in the second (9.4 ml) or third quartile (12.7 ml). Such differences possibly cannot be explained by considerable differences in life-long iodine intake any more and that is the reason why some factors different from iodine deficiency should be taken into account. Among them perhaps hereditary factors (including ethnical and autoimmune ones) and environmental factors (such as persistent chlorinated pollutants) should be considered first. It is postulated that sufficient iodine intake in Slovakia for last 40-50 years is a prerequisite for evaluating the role of such factors. Short overview of epidemiological studies from Slovakia published elsewhere is presented showing possible participation of hereditary factors. Thus, one study showed increased thyroid growth in a group of children followed for 7 years which was independent of iodine supplementation. Another study showed significantly different ThV in several pairs of siblings born within the interval of less than 24 months. Since such siblings took the same meals for the whole life in the same family and in the same school, they apparently had about the same life-long intake of iodine and thus the differences in ThV cannot result from iodine deficiency of one member of the pair. In addition, possible effect of environmental pollutants on ThV in a cohort of more than 2 000 adults with the same long-term iodine intake was observed. Finally, it is underlined that the upper limit of optimal iodine intake starts to be equally important as the lower limit and that such circumstance turns out to be of considerable importance. Japan is presented as a country with historically permanent very high iodine intake where any problem of endemic goitre from iodine deficiency never existed. However, possibly reversible goitre from megadoses of iodine exists, while the question of prevalence of autoimmune thyroid disorders does not seem to be definitely solved because of the lack of large epidemiological surveys in general population.
Lactic acid bacteria in food can transiently colonize the intestine and exert health beneficial (probiotic) effects. These include: 1. Lactose digestion, improvement of diarrheal disorders (including traveller's diarrhea), prophylaxis of intestinal and urogenital infections--as a result of formation or reconstruction of a balanced indigenous microflora. 2. Inhibition of the mutagenicity of the intestinal contents and reduction of the incidence of intestinal tumours. 3. Immunomodulatory effects resulting in the improved host resistance. 4. Depression of the serum cholesterol level. The most of these effects were observed in a group of adult subjects administered daily by a lyophilized Enterococcus faecium M-74 in the form of waffles (Dr. Ebi) during nine weeks of a double blind placebo controlled clinical trial. The bacterium temporarily colonized the host intestine and its secretion in stool persisted for six weeks after the last dose. The mean activities of beta-D-glucuronidase in stools of subjects given waffles containing enterococci were reduced comparing to stools of placebo subjects. After six weeks of daily eating the waffles with enterococci, an increased production of superoxide and other reactive oxygen intermediates by peripheral neutrophils was observed. The increase corresponded in time with an elevated formation of IgG by peripheral blood mononuclear cells after polyclonal activation with mitogenes. Higher activities of myeloperoxidase and elastase in peripheral neutrophils were also ascertained during eating of waffles containing of E. faecium M-74. Hence, intake of E. faecium M-74 in the form of waffles may have an significant immunostimulatory effect on both phagocytosis performed by neutrophils and antibody production. (Tab. 6, Ref. 29.)