Vol 41, No 6 (1995)

Clinical endocrinology
Role of training programs in the treatment of patients with type II diabetes mellitus
Surkova Y.V., Antsiferov M.B.
Abstract

According to the Ministry of Health of the Russian Federation, the number of patients with non-insulin-dependent diabetes mellitus (NIDDM) in Russia is currently 1.6 million. Providing effective treatment for NIDDM is a significant problem for domestic health in terms of both quantitative indicators and the quality of medical care. Successful therapy of this disease is impossible without changing the patient’s lifestyle. The treatment process affects such essential aspects of lifestyle as nutrition, physical activity, control of body weight, and continues throughout life. In this regard, the effectiveness of the traditional therapeutic approach to NIDDM is not high enough and, according to experts, the motivation to control and treat diabetes cannot be achieved without training.

Problems of Endocrinology. 1995;41(6):4-6
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Segregation analysis of diffuse toxic goiter
Kalinin А.Р., Sidorova О.Р., Kamynina Т.S.
Abstract

The authors discuss segregation analysis of diffuse toxic goiter based on 34 histories selected for the proband. In 11 families one of the parents and the child were ill, in 23 the proband’s parents were healthy. Weinberg’s method of solitary registration was used. No correspondence of the monogenic model of disease inheritance was observed for families with the hypothesized autosomal dominant and autosomal recessive types of inheriting.

Problems of Endocrinology. 1995;41(6):6-8
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Use of lipiodol, an iodinated oil preparation, in regions with moderate iodine defficiency
Sviridenko N.Y., Mayorova N.M., Nazarov A.N., Arbuzova M.I., Mischenko B.P., Gerasimov G.A.
Abstract

Lipiodol, an iodinated oil preparation, is used in many regions of the world characterized by severe iodine defficiency. The aim of this research was to assess the efficacy of this preparation in regions with slight and medium iodine insufficiency. A single dose of lipidol containing 200 mg iodine was administered to children aged 7 to 14 living in a region with moderate iodine deficiency, 452 of these living in town and 335 in the country. According to volumetry, the incidence of thyroid enlargement varied from 43 to 61% for different age groups and was reliably higher (p <0.001)) in the rural residents. The median of renal excretion of iodine varied from 4.5 to 9.2 microg% in the urban schoolchildren and from 3.8 to 5.8 microg% in the rural ones. One week after lipidol administration this value was 38.8, two weeks postadministration it was 30 microg%, in 3 months it was 16, and in 9 months 11.3 microg%. The incidence of thyroid enlargement has appreciably decreased and varied from 18 to 47% in different age groups. Hence, a single intake of lipiodol containing 200 mg of iodine ensures normal iodine excretion with the urine for 9 months since the drug administration and essentially reduces the prevalence of goiter in regions with moderate iodine insufficiency. Lipidol may be recommended as an alternative method of iodine prophylaxis for regions with slight and moderate iodine deficiency

Problems of Endocrinology. 1995;41(6):8-11
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Growth hormone releasing factor and assessment of growth hormone reserve in children
Tyulpakov A.N., Bulatov A.A., Peterkova V.A., Volevodz N.N., Yelizarova G.P.
Abstract

Pituitary somatotrophic reserve was assessed in children with growth delay using clofelin and growth hormone releasing factor (GH-RH). Thirty-four children hospitalized with suspected insufficiency of growth hormone (GH) were examined (22 boys and 12 girls aged 5.3 to 16.2, mean age 11.6±3.2). Bone age lagged behind the chronologic by 4.4+2.1 years, and signs of puberty were absent by the moment of hospitalization in all the children. Clofelin was administered orally in a dose of 0.15 microg/m2 body surface, GH-RH by intravenous jet in a dose of 1 mg/kg. The patients were divided into 3 groups with different response of GH to stimulation with clofelin and GH-RH: group A with a low GH output in both test (the pituitary form); group В with a low reaction to clofelin and normal response to GH-RH (the hypothalamic form); group C with increased level of response to both clofelin and GH-RH (idiopathic dwarfism). Group A included 14 children aged 11.7±2.9. Growth SDS in these children varied from -7.8 to -2.6 (-4.4±1.66). The maximal GH level after clofelin intake was 1.3 ± 1.6 ng/ml and after GH-RH infusion 3.5±2.51 ng/ml in group A. Group В consisted of 7 patients aged 12.0±4.4. Growth SDS in this group varied from -5.6 to 2.5 (- 4.0±1.3). The maximal level of GH in this group was 2.5±2.4 ng/ ml in clofelin test and 15.9±5.4 ng/ml in GH-RH test. Group C included 13 children aged 11.0±4.4, with growth SDS varying from -4.3 to -2.3 (-3.0±0.63). The maximal GH level after clofelin was 15.6±8.2 and after GH-RH 40.8±26.1 ng/ml, this being reliably higher than in group В (U=16.5, p=0.02). Hence, somatotrophic insufficiency was caused by hypothalamic disorders in approximately one-third of our patients.

Problems of Endocrinology. 1995;41(6):11-16
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Insulin loading and some hormonal metabolic parameters in patients with the hypothalamic syndrome
Sokolov Y.I., Zayev A.P., Khovanskaya T.P., Zhizhina S.A., Petrin S.V., Razin A.S., Filonov V.K.
Abstract

Thirty-two men aged 18 to 28 with the hypothalamic syndrome and 64 age-matched healthy men were examined. Insulin test was carried out in 3 steps: before and 30 and 120 min after intravenous infusion of 0.15 U insulin per kg b.w. At all stages of insulin test, spirography parameters reflected the status of hypermetabolism connected with increased energy consumption and with a lesser efficacy of oxygen utilization. Measurements of hormones: ACTH, STH, and hydrocortisone in the blood and of adrenaline, noradrenaline, dopamine, and DOPA in the urine indicated a reduced regulatory function of the hypothalamo-pituitary-adrenal and sympathoadrenal systems in patients with the hypothalamic syndrome. Time course of IRI, glucose, pyruvate, and lactate levels in the blood plasma of patients with the hypothalamic syndrome was indicative of reduced insulin and glucose tolerance and of impaired utilization of glucose as an energy substrate.

Problems of Endocrinology. 1995;41(6):16-19
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Hyperprolactinemia with the predominance of high-molecular immunoreactive prolactin: differences in the regulation of the levels of high-molecular and monomer forms in the blood
Bulatov A.A., Makarovskaya Y.Y., Marova Y.I., Melnichenko G.A.
Abstract

The effect of drug stimulation of prolactin secretion on the level of its high-molecular (100 kD) and monomeric (23 kD) immunoreactive forms in the blood serum was studied in 5 women with idiopathic hyperprolactinemia with the predominance of the high-molecular form of the hormone. Metoclopramide, a dopamine receptor antagonist, was used for stimulation of prolactin secretion. Fractionation of blood serum immunoreactive prolactin was earned out using gel filtration. A single intravenous infusion of metoclopramide caused a rapid appreciable increase of the total level of immunoreactive hormone, mainly at the expense of its monomer fraction. In contrast to the monomer form, high-molecular prolactin poorly reacted to suppression of the dopaminergic tone. The time course of high- and low-molecular (monomer) forms’ response to metoclopramide differed. The results indicate differences in the regulation of the levels of high- and low-molecular immunoreactive forms of prolactin in the blood of patients with hyperprolactinemia with the predominance of high-molecular hormone and, hence, permit a hypothesis on a different biochemical nature of these two forms and on other than hypophyseal origin of the high-molecular form or its bulk.

Problems of Endocrinology. 1995;41(6):19-23
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Levels of glucocorticoids and adrenal androgens in remote periods after adrenalectomy
Goncharov N.P., Trofimov V.M., Gavrilov A.G., Vorontsov V.I., Kolesnikova G.S.
Abstract

The levels of the major exogenous glucocorticoids, hydrocortisone and corticosterone, and adrenal androgens, dehydroepiandrosterone and its sulfate, were measured in the blood plasma of patients with Cushing’s disease and syndrome 3 and 10 years after uni- or bilateral adrenalectomy. Secretion of both C21 and C19 steroids, although lower than in health, was observed in all the patients. Daily rhythm of steroid release into the blood was as a rule impaired in patients after bilateral adrenalectomy, whereas in those after unilateral adrenalectomy a normal daily time course of the tested steroid levels in the blood was observed. Functional dexamethasone test showed differences in the time course of steroid response in patients subjected to bilateral adrenalectomy vs. that in normal subjects, whereas the adrenal left after unilateral adrenalectomy reacted to dexamethasone similarly as in health. These data reliably evidence the presence of functioning “extra” tissue in patients with Cushing’s disease after bilateral adrenalectomy.

Problems of Endocrinology. 1995;41(6):23-27
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Case Reports
Hypoglycemias deliberately induced by insulin in diabetic children
Kurayeva T.L., Remizov O.V.
Abstract

Hypoglycemic conditions are one of the complex problems in modern medicine. Among patients with diabetes mellitus (DM), obvious and asymptomatic hypoglycemia, according to various authors, are recorded in 25–58% of patients. Asymptomatic hypoglycemia is more often observed at 3 o'clock. Severe hypoglycemia as a cause of death occurs in 0.25-0.05% of cases of insulin therapy. There are few reports of deliberately induced hypoglycemia in patients with diabetes. This is more often observed in young girls and is considered as one of the options for Munchausen syndrome. The authors observed three such patients in Endocrinology research centre, the article presents one of these cases.

Problems of Endocrinology. 1995;41(6):27-29
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For practitioners
Prevention and treatment of diabetic microangiopathy: A lecture
Dreval A.K.
Abstract

One of the main complications leading to high disability and mortality in patients with diabetes mellitus is atherosclerotic vascular disease (diabetic macroangiopathy). At the same time, the frequency of atherosclerosis among patients with diabetes mellitus is significantly affected by the so-called risk factors for atherosclerosis. In particular, the incidence of atherosclerosis among the general population and among diabetics increases with increased levels of cholesterol (cholesterol) in the blood, blood pressure, smoking and obesity. However, in patients with diabetes mellitus, mortality, for example, from coronary heart disease increases by 3 times against any of the known risk factors. But even without risk factors, the frequency of atherosclerotic vascular damage in patients with diabetes is much higher than in non-diabetic patients, i.e. diabetes in itself is a risk factor for atherosclerosis.

Problems of Endocrinology. 1995;41(6):29-34
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Experimental endocrinology
Reactions of the paraventricular hypothalamic nucleus and dorsal motor nucleus of vagus of rats to changes of the gravitational environment
Fidelina О.I., Gorbatyuk O.S., Krasnov I.B., Akmayev I.G.
Abstract

Morphologic study of the paraventricular hypothalamic nucleus (PVN) and of the dorsal nucleus of the vagus (DNV) in the brain of Wistar-SPF rats exposed to weightlessness during a 14-day mission on Cosmos-2044 biosatellite and to Earth gravitation during 811 h after landing showed a reliable reduction of the cross-sectional area of the nucleolus in the neurons of the median parvicellular subnucleus, an increase of this parameter in the neurons of the lateral magnocellular subnucleus, and a trend to its decrease in the neurons of the posterior parvicellular subnucleus. As for the DNV, a reliable decrease in the cross-sectional area of the nucleolus in the neurons and an increased number of neurons with high and moderate acetylcholinesterase (ACE) and butyrylcholinesterase activities of its rostral portion were revealed, as well as a reduction of the number of neurons with high and moderate ACE activity in the median portion of DNV. In the caudal portion of DNV no reliable changes in the studied parameters were detected.

Problems of Endocrinology. 1995;41(6):35-38
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Hypoglycemic effect of stress exposures and their use for experimental prevention of diabetes mellitus
Volchegorsky I.A., Tseilikman V.Е., Kolesnikov O.L., Kostin Y.K., Kolesnikova A.A., Skobeleva N.A., Vyazovsky I.A., Lifshits R.I.
Abstract

The effects of acute and chronic immobilization stress and of a biogenic stressor, prooxidant (neutrophilokin) on the level of glycemia and resistance to diabetogenic exposures were studied in rats. A relationship between the poststress changes in glycemia and the regime of food intake has been revealed: acute stress on an empty stomach led to hypoglycemia, whereas stress without alimentary deprivation caused hyperglycemia. Prestress of fed animals abolished the hypoglycemic effect of stress on an empty stomach and transformed it into a hyperglycemic reaction which could be prevented by obsidan. Stress-induced hypoglycemia was realized against the background of reduced sensitivity to glucocorticoids and increased insulin sensitivity, with the concentration of the circulating hormone unchanged. The detected regularities are regarded as the mechanism of diabetes preventing action of chronic stress upon alloxan challenge. Repeated immobilization stresses in parallel with obsidan injections are characterized by the highest preventive effect.

Problems of Endocrinology. 1995;41(6):38-42
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Reviews
Molecular pathogenetic aspects in the diagnosis of thyroid cancer
Troshina Y.A., Gerasimov G.A., Alexandrova G.F.
Abstract

Thyroid cancer accounts for 1 - 1.5% of all malignant neoplasms. In recent years, there has been a trend towards an increase in the prevalence of this disease. On the one hand, the frequency of detection of thyroid cancer is associated with the introduction of a number of modern methods of examining patients and the increased oncological alertness of doctors. On the other hand, there is evidence of an increase in the incidence of thyroid cancer associated with an unfavorable environmental situation. An example of this is an increase in the frequency of thyroid damage in people exposed to radiation after the accident at the Chernobyl nuclear power plant. There is evidence that in Japan, thyroid cancer is detected 10 times more often among the population that has undergone nuclear bombing than among other residents of the country. Exogenous risk factors include external x-ray irradiation, previously carried out for medical purposes for various benign and non-tumor diseases of the head and neck. It is believed that exogenous factors are able to more or less affect the thyroid gland and cause a number of molecular changes in it that lead to the development of cancer. The purpose of this review was to summarize the current knowledge of the molecular aspects of thyroid cancer.

Problems of Endocrinology. 1995;41(6):42-47
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Information
Diabetologic Training Program for endocrinologists of Moscow devoted to type II diabetes mellitus
 
Abstract

In April 1995, the Diabetes Education Program was opened for endocrinologists on type II diabetes mellitus. The emergence of this initiative is due to the need to significantly improve the quality of medical care for patients with type II diabetes mellitus at the primary care level of specialized medical care.

Problems of Endocrinology. 1995;41(6):47-48
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Anniversary
P. A. Wunder (on the occasion of the 90th birthday annivetsary)
 
Abstract

May 5, 1995 marks the 90th anniversary of the birth of a talented scientist, wonderful teacher, wonderful person Pavel Abramovich Wunder. P.A. Wunder, who has devoted himself to serving science since his student years, is a highly erudite scientist, a well-known theorist and researcher. Throughout his creative life, P. A. Wunder has been developing a scientific direction in the study of the interaction of endocrine glands, their nervous regulation, and physiology of reproduction. P.A. Wunder combines a high level of professional qualification with a broad biological horizons, which allowed him to creatively develop and deepen the concept of plus-minus interaction by his teacher M. M. Zavadsky, bringing it in line with the achievements of modern science.

Problems of Endocrinology. 1995;41(6):48-48
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