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Vol 40, No 3 (1994)

Clinical endocrinology
Maternal diabetes mellitus as a risk factor in development of renal disorders in children
Sergeyeva K.M., Yevsyukova I.I., Zayachnikova T.Y.
Abstract

Forty-four children of diabetic mothers aged 10.5 years on an average were examined. Ultrasonography and renography with l23I were used to assess these children’s renal status. Various malformations (double kidneys, kidney agenesia, fused of floating kidneys) were detected in 10 patients, in 95 various functional renal disorders were revealed. The authors suppose that maternal juvenile diabetes mellitus, nephropathy, hydramnion, and poor metabolic control during a diabetic pregnancy result in abnormal development of fetal kidneys.

Problems of Endocrinology. 1994;40(3):4-6
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Distribution of the total quantity of fatty acid double bonds in lipid components of the blood in children with diabetes mellitus
Turkina T.I., Marchenko L.F., Sapelkina L.V., Poznyak T.I., Kiselyova Y.V.
Abstract

Children suffering from insulin-dependent diabetes mellitus (IDDM) were examined for unsaturation, that is, total quantity of double bonds in individual fractions of blood serum lipids was assessed. Lipid fractions were isolated by thin-layer chromatography. Unsaturation was assessed by ozonation method. The research was aimed at elucidation of biochemical criteria of the degree of metabolic disorders in children with IDDM and at development of methods for quantitative assessment of such disorders. Thirty-two inpatients with IDDM aged 7 to 15 were examined over time. Control group included 10 healthy age-matched children. Twenty children were examined during compensation stage (group 1), twelve during decompensation with ketoacidosis (group 2). Total unsaturation parameters were found reliably decreased in children with IDDM both during compensation and decompensation stages vs. those in healthy controls. A relative decrease of unsaturated fatty acids in the fraction of uneterified fatty acids (p<0.05) was characteristic of group 2, with the content of their fragments in triglyceride fraction being the maximal (p<0.05). The pattern of total unsaturation distribution in serum lipid fractions may serve as an indicator for metabolic disorders and decompensation in IDDM.

Problems of Endocrinology. 1994;40(3):6-8
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Atherogenic characteristics of oral sugar-reducing sulfonylurea derivatives
Maxumova M.A., Sobenin I.A., Balabolkin M.I., Orekhov A.N.
Abstract

The authors have examined the effects of sulfonylurea drugs glybenclamide and glypizide and of their analogs manilil and minidiab on cholesterol levels in murine peritoneal macrophages. Both glybenclamide and glypizide had a direct atherogenic effect on cultured murine peritoneal macrophages. A similar effect was observed in vivo: blood sera of diabetics after a single intake of 5 mg of manilil or minidiab increased the atherogenic potential of cultured murine peritoneal macrophages.

Problems of Endocrinology. 1994;40(3):8-10
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Effect of high tocopherol doses on lipid peroxidation and insulin secretion in patients with non-insulin-dependent diabetes mellitus
Balabolkin M.I., Mikhailova Y.V., Knyazeva A.P., Pankova S.S.
Abstract

Forty-one patients with type 2 diabetes mellitus were examined, divided into four groups administered various types of treatment: (1) diets, (2) predian, (3) glybenclamide, and (4) sugar-reducing drugs and insulin. All the patients were prescribed vitamin E in daily doses 600 and 1200 mg. The results indicate that vitamin E in high doses stimulates pancreatic insulin-producing function and is conducive to normalization of lipid peroxidation no matter what kind of therapy is administered.

Problems of Endocrinology. 1994;40(3):10-12
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Biosynthetic insulin effect on red cell membrane lipid peroxidation in patients with insulin-dependent diabetes
Balashova T.S., Golega Y.N., Rudko I.A., Balabolkin M.I., Kubatiev A.A.
Abstract

The aim of our research was elucidation of a relationship between red cell membrane lipid peroxidation (LPO) and antioxidant' defense enzymes, on the one hand and the age disease duration and presence of vascular complications in patients with type I diabetes mellitus on the other. The possibility of correcting red cell peroxide status with human insulin preparations was investigated. Red cell membrane LPO was found increased more than twofold and antioxidant defense enzymes activities virtually unchanged vs. controls in 16 patients with diabetes aged 20 to 43. These characteristics of red cell peroxidation status do not depend on patients’ age disease standing or presence of vascular complications. A twelve-week therapy with biosynthetic insulin resulted in complete normalization of LPO processes in patients with angiopathies aged under 35 and with disease standing of less than 10 years. In diabetics with angiopathies aged over 35 and disease standing of more than 10 years red cell MDA level reduced under the effect of therapy with human insulin preparations but was still increased vs. that in healthy donors by 1.5 times. Red cell GP and SOD activities reduced in the course of insulin therapy in all the examined groups of diabetics. Catalase activity increased by approximately 50% in patients with angiopathies those aged over 35 and a disease standing of more than 10 years under the effect of insulin. In the rest groups of patients catalase activity did not differ from its initial level. Our results permit us recommending besides human insulin preparations antioxidant therapy for patients with vascular complications those aged over 35 and a disease standing of more than 10 years.

Problems of Endocrinology. 1994;40(3):12-15
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Efficacy of program for treatment and training of patients with type 1 diabetes
Starostina Y.G., Antsiferov M.B., Galstyan G.R., Dedov I.I.
Abstract

The authors analyze the results of comprehensive, prospective, controlled investigation of the program for intensive care and training of 121 patients with insulindependent diabetes mellitus (IDDM). The basic principles of the program are training on a team’s basis, intensive insulin therapy, automonitoring of metabolism, and liberal diet. The results demonstrate that glycemia level approaching the normal may be attained and maintained in the majority of patients without increasing the risk of grave hypoglycemia, cases with severe diabetic ketoacidosis may be eliminated, and periods of temporary invalidity of patients reduced by 7-10 times. The selected training program was equally effective for patients of various age groups and levels of education, as well as for patients with “labile” diabetes. Results of treatment did not depend on the type of insulin preparations used. The authors conclude on a higher efficacy of new strategy of IDDM treatment in comparison with the traditional approaches.

Problems of Endocrinology. 1994;40(3):15-19
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Analysis of the quality of primary health pare rendered to patients with type 1 diabetes mellitus
Antsiferov M.B., Starostina E.G., Galstyan G.R., Dedov I.I.
Abstract

A prospective follow-up of a random sample of patients with insulin-dependent diabetes mellitus revealed a marked decompensation of carbohydrate metabolism in 98% of the examinees, a high incidence of diabetic ketoacidosis, a long duration of temporary invalidity, and poor adherence of patients to medical recommendations. Assessment of primary health care rendered to patients with type 1 diabetes at district outpatient clinics of Moscow demonstrated its poor efficacy and a necessity to improve the level of specialized diabetologic care.

Problems of Endocrinology. 1994;40(3):19-22
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The hypothalamo-hypophyseal system in patients with multinodular colloid euthyroid goiter
Makarov A.D., Keda Y.M., Kryukova I.V., Goncharov N.P., Pankova S.S., Komolov I.S., Bazarova E.N., Artyomova A.M., Serpukhovitin S.Y., Kozlov G.I., Yanushevich Y.S.
Abstract

Eighty patients with multinodular colloidal euthyroid goiter were examined. Thyrotropin-releasing hormone (TRH) test was carried out in 22 patients and 7 healthy women. The results of the test indicate a clear-cut tendency to reduction of hypophyseal TTH reserve in patients with multinodular euthyroid goiter with enlarged thyroid. In other words, clinical diagnosis of an euthyroid condition in the examinees appears to be groundless, particularly in patients with stage IV multinodular euthyroid goiter who may be referred to latent hyperthyrosis group on the basis of TRH test results. Three types of STH reaction were revealed by TRH test in these patients. The authors put forward a hypothesis on STH contribution as a growth factor to the pathogenesis of multinodular colloid euthyroid goiter.

Problems of Endocrinology. 1994;40(3):22-25
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Prolactinaldosterone humoral system in patients with postoperative hypothyrosis and arterial hypertension
Ustinova S.Y., Mychka V.B., Gerasimov G.A.
Abstract

Clarification of the possible pathogenetic relationship of hypothyroidism and arterial hypertension (AH) is relevant for the clinic in connection with two well-known observations: normalization of blood pressure in such patients on the background of thyroid hormone replacement therapy and the hypotensive effect of thyroid drugs in some patients with essential hypertension. AH, according to various authors, is detected in 10-50% of patients with hypothyroidism.

The literature discusses two possible mechanisms for the formation of hypertension in hypothyroidism: the presence of a volume factor and increased sympathetic activity. With the greatest constancy in such patients suppression of renin activity is detected, in some cases, an increased content of norepinephrine in the blood plasma and increased excretion of it in the urine are determined. Hyperprolactinemia, often observed in hypothyroidism, hyperaldosteronemia, detected in some cases in patients with hypothyroidism and hypertension, are of particular interest in connection with the known data on the inhibitory factor common to both hormones - the dopaminergic activity of the hypothalamus.

Given the general dopaminergic mechanism of regulation of prolactin (PRL) and aldosterone (A), it is logical to assume that the combined hyperproduction of both hormones may be due to a deficiency of dopaminergic activity.

According to our own preliminary observations, hypertension, which has developed or worsened due to postoperative hypothyroidism, is associated with low renin activity, hyperprolactinemia and hyperaldosteronemia, corrected by the dopaminergic receptor agonist - parlodel.

The aim of this work was to study the relationship in the PRL - A system in patients with hypertension that developed after resection of the thyroid gland.

Problems of Endocrinology. 1994;40(3):25-28
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Spermatogenesis disorders in transsexuals
Kozlov G.I., Kalinchenko S.Y., Slonimsky B.Y.
Abstract

Examinations of the semen in 8 patients with male transsexualism revealed stereotypical changes in spermograms ranging from oligo- to azoospermia. Possible mechanisms responsible for this abnormality are discussed.

Problems of Endocrinology. 1994;40(3):28-29
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Case Reports
A case of transsexualism among close relatives
Kozlov G.I., Kalinchenko S.Y.
Abstract

Transsexualism (TS) is a mismatch between sexual auto-identification and biological and genetic sex.

This is a rather rare pathology. According to most authors. male TS significantly prevails over female (3:1 ratio).

Over the period from 1980 to the present, we have observed 149 patients with TS, including 124 with female TS (transgender women and men) and 20 with male TS (transgender men and women). According to our observations, female TS prevails over male in a 3:1 ratio, which is at variance with data from researchers in other countries. The question of the reasons for this discrepancy remains to be answered.

The essence of the TS is still completely unclear. However, attempts to interpret the pathogenesis of TS from a purely psychiatric perspective, that is, within the framework of a depersonalization syndrome, are now completely abandoned. Recently, much attention has been paid to genetic and endocrine factors that can create the prerequisites for the development of TS.

Problems of Endocrinology. 1994;40(3):30-30
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For practitioners
Liberal diets in type I diabetes mellitus (Review of literature and authors’ data)
Starostina Y.G., Galstyan G.R., Dedov I.I.
Abstract

The treatment options for insulin-dependent (T1DM) and insulin-independent (T2DM) diabetes mellitus are significantly different, although they have a number of common goals (eliminating the symptoms of hyperglycemia, minimizing the risk of hypoglycemia, and preventing micro- and macroangiopathies). The main method for the correction of hyperglycemia in T2DM is the normalization of body weight (BW) with a low-calorie diet and increased physical activity. With T1DM, the genesis of which is associated not with excess BW, but with autoimmune death of p-cells and insulin deficiency, insulin replacement therapy is the main treatment method, and dietary restrictions for T1DM patients, according to modern views, are auxiliary and should be prescribed only to the extent in which their insulin therapy is different from the physiological secretion of insulin.

The fundamental principles of traditional diet therapy for T1DM have been critically reviewed in recent years. The most important requirement of traditional dietetics is the so-called "calorie balance"; hence, with an excess BW, a hypocaloric diet is usually recommended, with a deficiency of BW, a diet with a high calorie content, and with normal BW, one that guarantees the maintenance of BW. However, it has recently been proven that with normal BW, the lowest rates of morbidity and mortality are by no means always observed. In contrast, the highest expected life expectancy was found in individuals with relatively small excess BW. Based on this, patients with T1DM are unlikely to strive at all costs for a true "ideal weight". A diet with a reduced number of calories compared to a healthy person with the same physical activity cannot provide a patient with T1DM with a normal weight of sufficient physical performance. A deficiency of carbohydrates leads to an insufficient supply of energy to the body. In adults, this is manifested by a decrease in working capacity, in children - by a lag in physical development. In addition, insufficient intake of carbohydrates is accompanied by the emptying of glycogen depots in the liver and an increased risk of hypoglycemia. With a deficiency of carbohydrates, endogenous fats begin to be consumed as an energy source, which leads to acetonuria.

Problems of Endocrinology. 1994;40(3):31-35
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Goiter relapses
Goch Y.M., Kudryashov V.K., Belyayev P.A.
Abstract

The problem of relapse of goiter is still considered insoluble. Postoperative relapses of goiter are observed quite often - from 1.8 to 39%.

The severity of the problem of recurrent goiter is that at present, patients suffering from this disease can be attributed to the group of "increased oncological risk" in relation to thyroid cancer. Malignancy of recurrent goiter, according to various authors, is observed with a frequency of 8.1 to 20%. Malignancy occurs “hidden” without clear clinical symptoms of thyroid cancer, and therefore surgical intervention is often performed at a stage that does not give optimal treatment results.

The second side of the problem is the technical features of the surgical treatment of recurrent goiter. The latter are caused by violations of the anatomical and topographic relationships of tissues, extensive scars and atypical location of the node. As a result, complications and mortality after repeated operations with goiter significantly exceed those after primary interventions. Therefore, one of the tasks of thyroid surgery is to find out the causes of relapse of goiter and reduce its frequency.

For this purpose, various methods of primary surgery, the intake of thyroid hormones in the postoperative period, etc. are proposed.

The reasons that lead to relapse of goiter are varied and depend primarily on the disease for which the patient was operated on primarily (diffuse toxic goiter, nodular goiter, multinodal, chronic autoimmune thyroiditis, etc.). To avoid relapse of goiter, a number of surgeons offer more advanced operations even with nodular goiter. However, the expansion of the volume of operation with nodular forms of goiter often leads to the development of persistent hypothyroidism.

Problems of Endocrinology. 1994;40(3):35-37
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Contribution of a family to treatment and rehabilitation of patients with pubertal juvenile dyspituitarism
Tereschenko I.V.
Abstract

Puberty-youthful (hypothalamic) dispituitarism (PD) is a disease of adolescence and adolescence, the obligatory pathogenesis factors of which are damage to the diencephalon and hypothalamic-pituitary-endocrine dysregulation: hypercorticism, hyperaldosteronism, hyperinsulinotinotropin dysregulation, tibiotensinotropin dysregulation, gonotropinotropin dysotropin syndrome . PD is a chronic disease with a long, sometimes lifelong course. His prognosis is primarily determined by the correctness and regularity of treatment, which largely depends on the awareness of the parents about the clinic, diagnosis, therapy, possible outcomes of PD. Due to the peculiarities of adolescent psychology, patients often do not want to be treated, considering themselves healthy (this is very typical for boys), or do not seek medical help due to a severe astheno-depressive state, which is more typical of girls.

Our long-term experience shows that patients come especially late in cases when the family has obese relatives and adolescent obesity does not cause serious anxiety in relatives. It is very important to conduct broader public health education on PD issues. A gross medical error should be considered a frequently encountered fact when a doctor refuses treatment for a patient with a PD, motivating: “This will pass:”. Indeed, in terms of severity, PD is mild, moderate, and severe. However, it should be remembered that any stressful situations, infections, traumatic brain injuries, etc. can change the subclinical course of the disease in an unfavorable direction, which must be explained to the patient and parents; and vice versa, even severe forms of PD, when a patient has IV degree obesity, can end in complete recovery with proper systematic treatment.

Problems of Endocrinology. 1994;40(3):37-39
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Experimental endocrinology
Insulin secretion by isolated rat pancreas under the effect of prooxidants: A relationship with glutathione release
Sitozhevsky A.V., Dusta I.V., Trofimov A.V., Ivanov V.V., Karpenko O.A.
Abstract

Rates of basal and glucose-stimulated insulin and glutathione secretion were studied in experiments with isolated rat pancreas, as were prooxidant effects on these values. The rate of oxidized and recovered glutathione release was found increased at glucose concentration increase to 16.7 mmoles in perfusion solution. Addition of prooxidants (tret- butyl hydroperoxide and Fe2+) in concentrations 10~4 mole did not change basal insulin secretion but resulted in reduction of glucose-stimulated hormone release. Under such conditions a reduction of the rate of oxidized and recovered glutathione release by the pancreas was observed which was adequate to changed GSH/GSSG ratio in isolated Langerhans’ islets. It may be supposed that lipid peroxidation results in changed thiol-disulfide ratio in Langerhans’ islets В cells and in reduction of their sensitivity to secretogen effect.

Problems of Endocrinology. 1994;40(3):39-41
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Insulin and adrenalin effects on the activity and concentration of glutathione metabolizing enzymes in rat organs
Kolesnichenko L.S., Kulinsky V.I., Yasko M.V., Pensionerova G.A., Grudinina Y.V.
Abstract

Adrenaline activates glutathione peroxidase in the heart, liver, and kidneys and glutathione transferase in the heart and liver, inhibits gamma-glutamyl transferase in the kidneys, and has no effect on glutathione reductase; no changes in the brain detected. Insulin does not influence glutathione reductase either, nor does it induce any changes in the heart, liver, and bone marrow, but it alters (as a rule reduces) in a number of cases the activities of many glutathione metabolism enzymes and reduces glutathione concentration in the brain, kidneys, and spleen both an hour and 24 h after injection. The detected changes do not conform to universally acknowledged classification of the organs by insulin sensitivity and do not correlate with hypoglycemia.

Problems of Endocrinology. 1994;40(3):42-44
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Effect of I-131 incorporation on male rat reproductive system and the dose-dependent effect
Tarasenko L.V., Varga S.V., Demchenko V.N., Bolshova Y.V., Nosenko N.D., Sinitsyn P.V., Chaikovskaya L.V., Reznikov A.G.
Abstract

Radioactive 131I was injected in single doses 9.25, 37, and 92.5 kBq to prepubertal (30-day-old) male rats. Iodine incorporation in doses 37 and 92.5 kBq resulted in some functional changes in the reproductive system of mature rats: blood testosterone level increased, its hypothalamic aromatization intensified, and biologically active LH level in the blood dropped. Incorporation of 9.25 kBq of 131-I had no effect on male reproductive system. A possibility of direct injury to rat testicles by 131I incorporation is suggested.

Problems of Endocrinology. 1994;40(3):45-47
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Effect of female sex steroids on splenocyte ability to produce an adoptive immune response. Role of prostaglandin F2a in hormonal immunoregulation mechanisms
Shirshev S.V., Shilov Y.I., Kevorkov N.N.
Abstract

Male CBA mice were used in experiments. Splenocytes were incubated for an hour in macrocultures with estradiol (E2) or progesterone (P), then the cells were transferred (together with the antigen) to lethally irradiated syngeneic recipients, and on day 4 the count of antibody-producing cells (APC) was estimated. Prostaglandin F2a (PGF2a) concentrations were radioimmunoassayed in cell culture supernatants. E2 and P concentrations corresponded to these hormones levels in blood sera during pregnancy. E2 and P in the tested concentrations were found to reliably stimulate the processes of APC formation, their effects being dose independent. Both E2 and P statistically reliably increased PGF2a level in splenocyte culture. Fractionation of splenocytes helped reveal the highest PGF2a level in the cultures devoid of adhesive cells and rich for T lymphocytes. Hence, E2 and P stimulated the processes of antigen-independent differentiation of splenocytes producing APC either by directly stimulating T lymphocytes or via macrophages by blocking their negative effects. Stimulation of adoptive immune response by sex steroids is closely connected with PGF2a production by immunocompetent cells under the effects of these hormones.

Problems of Endocrinology. 1994;40(3):47-49
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Reviews
Hormones and osteoporosis
Shiraliyev O.K., Mamedov T.F., Gaghiyeva Z.I.
Abstract

Osteoporosis and its complications - bone fractures - represent a significant medical and social problem. Due to osteoporosis, bone fractures occur annually in 1.3 million Americans and 40 thousand Canadians. In France, one in two, and in Australia, one in five women aged about 70 years, suffer from fractures caused by osteoporosis. The occurrence of osteoporosis in old women is due to a decrease in estrogen production. However, a decrease in bone mineral density occurs not only with age, but even more so with all conditions leading to a change in the balance of hormones of the hypothalamic-pituitary system, thyroid and parathyroid glands, and adrenal glands.

In connection with the stated purpose of this work was a synthesis of literature data on the effect of hormones on the occurrence and development of osteoporosis.

Bone tissue is a dynamic metabolically active system. Depending on the function performed, cortical and trabecular bone are distinguished. The first makes up three quarters of the entire skeletal mass, forms the diaphysis of the tubular bones, has a low porosity, performs the function of supporting soft tissues and transmitting muscle contraction from one part of the body to another. Trabecular bone tissue makes up one fourth of the mass of the skeleton, forms the bones of the axial skeleton and the epiphysis of the tubular bones, has high porosity and ensures normal vital activity of the bone marrow. To do this, in the trabecular bones there are cavities ranging in size from 500 to 1000 microns, located between bone plates 100-150 microns thick.

The basis of the vital activity of bone tissue is the functioning of two types of cells: osteoclasts resorbing the bone, and osteoblasts responsible for its formation. The ancestors of these cells are not fully understood, although hematopoietic monocyte macrophages are considered the most probable for osteoclasts, and stromal cells for osteoblasts, from which preosteoblasts arise.

Throughout life, there is a constant renewal of bones, manifested in the resorption of individual, very small sections of tissue, with the almost simultaneous formation of a new bone. This process is of great evolutionary importance, since it allows you to remove microtrauma and bone microcracks that arise during the life process. Annually 25% of the mass of the trabecular bones and only 2-3% of the cortical bones are renewed.

Problems of Endocrinology. 1994;40(3):49-52
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Antiprogestines
Sergheyev P.V., Kareva Y.N., Tkacheva N.Y., Vysotsky M.M.
Abstract

Antiprogestins are steroid compounds that have a high ability to bind to progesterone cell receptors and thus prevent their binding to endogenous steroid hormone.

The first achievements in the search for progesterone antagonists were obtained in the laboratories of well-known companies Roussel-Uclaf and Schering AG, where hundreds of Hp-arylsteroid derivatives were synthesized, of which the most common were mifepristone (RU 38486), lilopristone (ZK 08734), onapriston (ZK 08200 )

At present, antiprogestins are used as implantation inhibitors, contraceptives, drugs used in Itsenko-Cushing's disease.

In most cases, antiprogestins are administered to women of active reproductive age.

Problems of Endocrinology. 1994;40(3):52-54
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Incidence of thyroid cancer and epidemiologic determinants of the condition: Role of ionizing radiation
Tronko N.D., Boguslavsky V.P., Prisyazhnyuk A.Y., Bolshova Y.V.
Abstract

As a result of the Chernobyl accident, a significant part of Ukraine was contaminated with radionuclides. According to UNSCEAR, the activity of material released into the environment from the destroyed active zone of the reactor was about 50 MKi, among which the share of radionuclides of iodine, cesium and tellurium was 10-20%. Despite the fact that the prompt implementation of iodine prophylaxis made it possible to reduce the dose load on the thyroid gland, nevertheless, a significant part of the child and adult population received radiation doses of the thyroid gland, which pose a serious danger in the development of possible long-term oncological consequences. Based on dose calculations according to the most conservative model of “single dose” of radioactive iodine, the number of children living in the 8 most affected areas of Ukraine affected by iodine radionuclides and exposed to doses in excess of 200 cGy is estimated to be 12,000 or more, in the dose range up to 200 cGy - 79 500, up to 30 cGy - 38 000.

Available information on thyroid doses in Ukraine’s population, on the one hand, and information on the carcinogenic effects of this organ’s radiation, accumulated to date in the world, on the other hand, indicate the need for carefully planned epidemiological studies aimed at assessing the risk of this pathology in victims. At the same time, the effectiveness of such studies, and, consequently, the development of preventive measures to reduce the effects of radiation in the future, will largely depend on taking into account the characteristics of the epidemiological study of the role of the radiation factor in the development of thyroid cancer.

In connection with the foregoing, the aim of this work was to generalize the information accumulated to date in the world, reflecting deficiencies in the study of the epidemiology of radiation-induced thyroid cancer, as well as confirming the need for further development and improvement of these studies.

Problems of Endocrinology. 1994;40(3):55-59
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«Essential» phospholipids in diabetes mellitus. Review of the results all over the world
Gundermann K., Kundurovich M.
Abstract

The purpose of the review is to evaluate the results obtained with the use of EPL (“essential” phospholipids) for the treatment of diabetes mellitus in the light of modern scientific knowledge, as well as to highlight the role of lipostabil in the treatment of diabetes mellitus. Since some studies did not set as their primary task the study of the effect of EPL on serum lipids and lipoproteins, and diabetes-specific parameters, such as blood glucose concentration, glycated hemoglobin (HbA1c), ketonemia, as well as possibilities, were put on the forefront. development of late complications (atherosclerotic vascular changes or retinopathy), then the evaluation of these studies was carried out in accordance with the measured parameters.

The most important studies were analyzed. Since the beginning of the 90s, interest in the use of lipostabil in the treatment of diabetes has grown markedly. This interest was reflected in a double “blind” study by R. Kirsten et al., Completed in 1993. To date, there are data on 650 patients with insulin-dependent and non-insulin-dependent diabetes mellitus; one study is mainly related to diabetic retinopathy. The duration of therapy ranged from 14 days to 39 months, in most studies - several months. In some cases, lipostabil was used only orally, in others, simultaneously with intravenous administration, or therapy began with intravenous administration of the drug and continued with the use of oral capsules. The treatment of EPL was initially carried out on the background of only a diet, and then in combination with oral antidiabetic drugs or insulin.

Problems of Endocrinology. 1994;40(3):59-62
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Current Events
Workshop on «Essential» Phospholipids in the Treatment of Diabetes Mellitus and Dyslipidemias
Bespalova V.A., Kundurovich M.
Abstract

A scientific and practical symposium “Essential phospholipids in the treatment of diabetes mellitus and dyslipidemia” organized by RON-PULENK RORER (Cologne, Germany) was held at the State Central Scientific Medical Library of the Ministry of Health of Russia.

The basic concept of the development of dyslipidemia (DLP) and the working classification of this metabolic state were presented in a report by Yu. A. Knyazev (Moscow). In the message K. Gundermann et al. (Cologne, Germany) the mechanism of action of essential phospholipids (EPL) at the molecular level, the level of insulin receptor and postreceptor interactions in cytomembranes, as well as in lipolytic and cholinesterizing enzyme systems was described.

The feasibility of using EPL preparations for the prevention of diabetic angiopathies (AP) by transplanting pancreatic incretory cell cultures, with conservative and surgical treatment of AP with the aim of stabilizing or even reversing the development of atherosclerotic vascular lesions, was substantiated in a report by A. A. Chirkin et al. (Vitebsk, Belarus). The results of the study of intravascular microcirculation in patients with diabetes with clinical signs of AP made it possible to evaluate lipostabil (a drug containing EPL and prescribed together with hypoglycemic agents) as an effective tool in the plasma-cell type of microcirculatory disorders in patients with diabetes aged 19 to 68 years (I. M Kakhnovsky et al., Moscow).

Under the influence of lipostabil forte, an increase in insulin sensitivity is possible (L. L. Vakhrusheva et al., Moscow), which underlies a decrease in the need for exogenous insulin and a tendency to normalize indicators of carbohydrate and fat metabolism, the level of counterinsulin hormones. 6 months after the start of lipostabil forte administration, an inhibition of AP progression was noted against the background of an adequate dose of insulin.

Problems of Endocrinology. 1994;40(3):63-63
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