1230
stage 0, no goitre; stage 1-A, goitre detectable only by palpation and not visible with the neck fully extended; stage 1-B, goitre palpable but visible only with the neck fully extended (this stage also includes nodular glands); stage 2, goitre visible with the neck in the normal position. Palpation was done by two specialists. 32% of children had goitre: 25% stage 1-A, 7% stage 1-B, and 0-1% stage 2. Goitre was more prevalent in girls than in boys (36% versus 28%). 23% of boys had stage 1-A goitre and 5% goitre stage 1-B; 27% of girls had stage 1-A, 9% stage l-B,andO’3% stage 2. In5 children in whom urinary excretion of iodine was measured, values were 146, 154, 198, 239, and 278 ug iodine/g creatinine, respectively. This study has confirmed the high prevalence of goitre among Krk children. Although the goitres were mainly grade 1-A, the prevalence of 32% indicates mild endemic goitre, despite the seemingly adequate iodine intake. The previous difference in goitre prevalence in the various parts of the island was not noted, but only a few children were investigated in some communities. Intensive population migration might also account for this change. Before the introduction of iodine prophylaxis it was assumed that other factors beside iodine deficiency, notably dietary goitrogens, might be implicated in the development of goitre on Krk. The production and consumption of kale (a known goitrogen4) in the goitrous area was at that time about twice as high as in other areas of the island. In 5 of 12 subjects with goitre the perchlorate test showed that the trapped iodine was not bound organically.s Nonetheless, the role of kale in the occurrence of goitre in Krk remained questionable since goitrogenic activity is decreased by cooking. Horvat and Maver suggested that in addition to a lack of iodine goitre might be attributable to vitamin A deficiency. A comprehensive investigation has now been initiated to reliably estimate goitre prevalence and iodine intake in Krk. Department of Nuclear Medicine and Oncology, University Hospital "Dr M. Stojanović", University of Zagreb, Zagreb, Yugoslavia; Institute of Public Health, Rijeka; and Institute of Public Health of Croatia, Zagreb
Z. KUSIĆ E. MESAROŠ SIMUNČIĆ N. DAKOVIĆ A. KAIC RAK LJ LUKINAC Š. SPAVENTI
1. Matovinović J. Endemic goiter and cretinism at the dawn of the third millenium. Am Ann Rev Nutr 1983; 3: 341-412. 2. Horvat A, Maver H. The role of vitamin A in the occurrence of goitre on the island of Krk, Yugoslavia. J Nutr 1958; 66: 189-203. 3. Delange F, Bastani S, Benmiloud M, et al. Definitions of endemic goiter and cretinism: classification of goiter size and severity of endemias, and survey techniques. In: Dunn JT, Pretell EA, Daza CH, Viteri FE, eds. Towards the eradication of endemic goiter, cretinism, and iodine deficiency. Washington: PAHO/WHO (scientific publication no. 502), 1986: 373. 4. Michajlovskij N, Sedlak J, Jušić M, Buzina R. Goitrogenic substances of kale and their possible relations to the endemic goitre on the island of Krk (Yugoslavia). Endocrinol Exp 1969; 3: 65-72. 5. Buzina R, Milutinović P, Vidović V, Maver H, Horvat A. Endemic goitre of the island of Krk studied with I131. J Nutr 1959; 68: 465-71.
Rapid diagnosis of testicular choriocarcinoma by urinary pregnancy tests SiR,—Urinary human chorionicgonadotropin (hCG) testing is important in the differential diagnosis of acute abdominal pain and vomiting in women.1 However, very occasionally its use in young men can prevent prolonged delay in the initiation of potentially curative treatment for metastatic choriocarcinoma. We report the use of this test in such a patient. A 21-year-old male university student was admitted to Harold Wood district general hospital from the casualty department after a transient loss of conciousness and 6 months’ history of backache and testicular swelling. He had lost about 6 kg in weight over the past 6 weeks. He had a left-sided scrotal swelling, with evidence of an underlying testicular or epididymal mass, hydrocoele, a liver enlarged to 5 fingers below the costal margin, bilateral gynaecomastia, and abnormal breath sounds. Chest radiography showed multiple rounded opacities, up to 5 cm diameter, in both lung fields. He underwent fme-needle aspiration of the scrotal fluid and liver biopsy, which showed seminoma. When seen by the visiting oncologist 10 days after admission his condition was deteriorating. He had ascites and signs of inferior vena cava
obstruction. Urea had risen from 13
to
26
mmol/I (normal 25-6
mmol/1), bilirubin from 30 to 179 ptnol/1 (
stage 0, no goitre; stage 1-A, goitre detectable only by palpation and not visible with the neck fully extended; stage 1-B, goitre palpable but visible only with the neck fully extended (this stage also includes nodular glands); stage 2, goitre visible with the neck in the normal position. Palpation was done by two specialists. 32% of children had goitre: 25% stage 1-A, 7% stage 1-B, and 0-1% stage 2. Goitre was more prevalent in girls than in boys (36% versus 28%). 23% of boys had stage 1-A goitre and 5% goitre stage 1-B; 27% of girls had stage 1-A, 9% stage l-B,andO’3% stage 2. In5 children in whom urinary excretion of iodine was measured, values were 146, 154, 198, 239, and 278 ug iodine/g creatinine, respectively. This study has confirmed the high prevalence of goitre among Krk children. Although the goitres were mainly grade 1-A, the prevalence of 32% indicates mild endemic goitre, despite the seemingly adequate iodine intake. The previous difference in goitre prevalence in the various parts of the island was not noted, but only a few children were investigated in some communities. Intensive population migration might also account for this change. Before the introduction of iodine prophylaxis it was assumed that other factors beside iodine deficiency, notably dietary goitrogens, might be implicated in the development of goitre on Krk. The production and consumption of kale (a known goitrogen4) in the goitrous area was at that time about twice as high as in other areas of the island. In 5 of 12 subjects with goitre the perchlorate test showed that the trapped iodine was not bound organically.s Nonetheless, the role of kale in the occurrence of goitre in Krk remained questionable since goitrogenic activity is decreased by cooking. Horvat and Maver suggested that in addition to a lack of iodine goitre might be attributable to vitamin A deficiency. A comprehensive investigation has now been initiated to reliably estimate goitre prevalence and iodine intake in Krk. Department of Nuclear Medicine and Oncology, University Hospital "Dr M. Stojanović", University of Zagreb, Zagreb, Yugoslavia; Institute of Public Health, Rijeka; and Institute of Public Health of Croatia, Zagreb
Z. KUSIĆ E. MESAROŠ SIMUNČIĆ N. DAKOVIĆ A. KAIC RAK LJ LUKINAC Š. SPAVENTI
1. Matovinović J. Endemic goiter and cretinism at the dawn of the third millenium. Am Ann Rev Nutr 1983; 3: 341-412. 2. Horvat A, Maver H. The role of vitamin A in the occurrence of goitre on the island of Krk, Yugoslavia. J Nutr 1958; 66: 189-203. 3. Delange F, Bastani S, Benmiloud M, et al. Definitions of endemic goiter and cretinism: classification of goiter size and severity of endemias, and survey techniques. In: Dunn JT, Pretell EA, Daza CH, Viteri FE, eds. Towards the eradication of endemic goiter, cretinism, and iodine deficiency. Washington: PAHO/WHO (scientific publication no. 502), 1986: 373. 4. Michajlovskij N, Sedlak J, Jušić M, Buzina R. Goitrogenic substances of kale and their possible relations to the endemic goitre on the island of Krk (Yugoslavia). Endocrinol Exp 1969; 3: 65-72. 5. Buzina R, Milutinović P, Vidović V, Maver H, Horvat A. Endemic goitre of the island of Krk studied with I131. J Nutr 1959; 68: 465-71.
Rapid diagnosis of testicular choriocarcinoma by urinary pregnancy tests SiR,—Urinary human chorionicgonadotropin (hCG) testing is important in the differential diagnosis of acute abdominal pain and vomiting in women.1 However, very occasionally its use in young men can prevent prolonged delay in the initiation of potentially curative treatment for metastatic choriocarcinoma. We report the use of this test in such a patient. A 21-year-old male university student was admitted to Harold Wood district general hospital from the casualty department after a transient loss of conciousness and 6 months’ history of backache and testicular swelling. He had lost about 6 kg in weight over the past 6 weeks. He had a left-sided scrotal swelling, with evidence of an underlying testicular or epididymal mass, hydrocoele, a liver enlarged to 5 fingers below the costal margin, bilateral gynaecomastia, and abnormal breath sounds. Chest radiography showed multiple rounded opacities, up to 5 cm diameter, in both lung fields. He underwent fme-needle aspiration of the scrotal fluid and liver biopsy, which showed seminoma. When seen by the visiting oncologist 10 days after admission his condition was deteriorating. He had ascites and signs of inferior vena cava
obstruction. Urea had risen from 13
to
26
mmol/I (normal 25-6
mmol/1), bilirubin from 30 to 179 ptnol/1 (
