Vol 42, No 5 (1996)

Clinical endocrinology
The national register of diabetes mellitus. Report 2. Epidemiology of insulin-dependent diabetes mellitus and incidence of its complications in children of Moscow
Dedov I.I., Lebedev N.B., Suntsov Y.I., Scherbacheva L.N., Kurayeva T.L., Maximova V.P., Gubanov N.V., Andrianova Y.A., Trofimenko Y.V., Kudryakova S.G., Ryzhkova S.V., Milenkaya T.M., Tokmakova A.Y., Galstyan G.R., Mischenko B.N., Arbuzova T.I., Knyazeva A.P., Andreichenko A.P., Pilyutik V.F.
Abstract

The National Register of Diabetes Mellitus in children living in Moscow has been created. By January 1, 1995 there were 892 children with insulin-dependent diabetes in Moscow. The prevalence and incidence of the disease were, respectively, 57 and 11.2 per 100,000 children. The degree of compensation of the metabolic control in the population in general was poor (Hb A1 — 13.4+2.8%, Hb Alc — 10.01±2%). The incidence of diabetic retinopathy, cataracts, sensory neuropathy, microalbuminuria, limited morbidity of the joints, growth delay was 4.5, 3.2, 3.3, 8.7, 7, and 3.1%, respectively.

Problems of Endocrinology. 1996;42(5):3-9
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Antioxidant systems of blood plasma in the pathogenesis of diabetic microangiopathies
Lebedeva Y.A.
Abstract

The parameters of lipid peroxidation and enzymatic and low-molecular antioxidant systems of blood plasma were studied in 114 patients with insulin-dependent diabetes mellitus and 51 donors (control group). The activities of extracellular superoxide dismutase, catalase, concentrations of plasma selenium, the activity of red cell glutathione peroxidase, and the level of uric acid were measured. Oxidant stress was found to involve no changes of the enzymatic component of antiperoxide defense in patients both at the debut of the disease and with diabetic angiopathies. Evidently, the cell protection is performed not by the enzymatic, but by the low-molecular antioxidant system. The level of total antioxidant activity of the plasma is increased in newly diagnosed diabetes and normalizes by the time of formation of microangiopathies. The concentration of uric acid - one of the plasma antioxidants - is reliably decreased in comparison with the control, which may be significant in the pathogenesis of microangiopathies.

Problems of Endocrinology. 1996;42(5):10-12
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Remote effects of exposure to pesticides and the incidence of diabetes mellitus in rural areas
Abusuyev S.A., Khachirov D.G.
Abstract

Diabetogenic effect of organochlorine, organophosphorus, and copper-containing pesticides and. to a lesser degree, of carbamates, has been established. Diabetes developed in remote periods after exposure to these agents. The relationship between diabetes incidence and the type of pesticide and its concentration used at a certain territory is statistically unreliable, which may be explained by the multifactorial nature of this disease; the correlation is medium-expressed. A greater diabetogenic action was observed for type II diabetes; the ecological risk index, characterizing the tendency to increase of the morbidity, is more informative. The authors explain the diabetogenic effect of pesticides by their general toxic action.

Problems of Endocrinology. 1996;42(5):12-14
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Glycosaminoglycans in therapy of diabetic nephropathy
Vorontsov A.V., Dedov I.I., Shestakova M.V., Milenkaya T.M., Knyazeva A.P.
Abstract

Sulodexide, a drug containing glycosaminoglycans, was used in the treatment of patients with type I diabetes. Along with their effects on the blood clotting system, glycosaminoglycans are capable of preventing the mesangial proliferation and hyperproduction of extracellular matrix, as well as thickening of the glomerular basal membrane and impairment of its permeability and charge selection. A reliable antiproteinuric effect of the drug was noted, persisting for 6 weeks after it was discontinued; the excretion of protein with the urine reliably decreased in patients with both, microalbuminuria and proteinuria. Moreover, an antiatherogenic effect (a reliable decrease of serum atherogenicity coefficient) of sulodexide was observed. Assessment of the status of the fundus oculi of diabetics treated with sulodexide demonstrated a positive dynamics during therapy in some of the patients with nonproliferative and preproliferative retinopathy; no deterioration as regards the fundus oculi were noted. Hence, addition of sulodexide to combined therapy of patients with diabetic nephropathy is effective and pathogenetically justified.

Problems of Endocrinology. 1996;42(5):14-18
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Therapy of the climacteric disorders in women with type II diabetes
Popkov S.A., Starkova N.T., Morozova T.P., Volobuyeva Y.V.
Abstract

The efficacy of estrogen-gestagen therapy of patients with climacteric syndrome is no longer doubted. Besides reducing the number of hot flashes, hyperhidrosis, etc., such treatment prevents atherosclerosis, osteoporosis, and atrophy of the external genitals. However, hormone replacement therapy of diabetics with climacteric syndrome involves a high risk of deteriorating carbohydrate metabolism. This study was aimed at elucidating the possibility of using Divine (Orion, Finland) for the treatment of patients suffering from climacteric syndrome in the presence of type II diabetes concomitant with coronary heart disease. The results indicate that the divine had a favorable impact on the course of the climacteric syndrome in the named patient population, appreciably improving the patient's quality of life and causing no decompensation of diabetes, which was confirmed by clinical and laboratory findings.

 

Problems of Endocrinology. 1996;42(5):18-20
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Efficacy of different starting doses of methimazole (mercazolil) in the treatment of diffuse toxic goiter
Burumkulova F.F., Kotova G.A., Gerasimov G.A.
Abstract

The purpose of this study was to investigate the effects of two different starting doses of methimazole (MMI) on the clinical and biochemical characteristics of patients with Grave's disease and, specifically, to elucidate the effects of various independent factors on the efficacy of MMI. Sixty untreated hyperthyroid patients were enrolled in the trial. Forty-six cases were newly diagnosed, 6 patients presented with relapse following prior therapy or surgery. Eight patients previously treated with MMI in a dose of 30 mg had to interrupt the treatment because of grave side effects; in our study they were administered the drug in a dose of 15 mg. All patients were residents of Russia, living in areas with moderate and mild iodine deficiency; they were divided in two equal groups, A and В with the starting daily doses of 15 and 30 mg MMI, respectively. Free T4 levels in the serum were measured and clinical examinations carried out 3, 4, and 5 weeks after the beginning of MMI therapy. In group A, 86.7% (26/30) patients were euthyroid after 3 weeks and 100% after 4 weeks versus 93.3 (28/30) and 96.7% (29/30) in group B. The time of euthyroidism onset did not depend on the starting dose of the drug (3.13±0.11 weeks in group A vs. 3.10±0.12 weeks in group B). No correlation could be traced between the dose efficacy and patients' age, disease standing, size of the thyroid, or presence of endocrine ophthalmopathy. Euthyroidism was attained significantly earlier in group В in comparison with group В (3.0±0 vs. 4.4±0.3 weeks) only in patients with very high initial levels of free T4 (<75 pmole/liter). There was only one case with minor complications in group A and two cases in group B. In addition, 8 patients in group A with a history of side effects of therapy with MMI in a dose of 30 mg were administered the drug in a dose reduced by half without adverse effects. Our data confirm the previous results that response to thyroid drugs depends mainly on the pretreatment free T4 levels. The majority of patients with Graves' disease from regions with iodine deficiency can be effectively controlled by small starting doses of MMI (e.g., 15 mg) with a lower risk of dose-dependent side effects.

Problems of Endocrinology. 1996;42(5):20-23
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Nodular goiter and thyroid cancer in children and adolescents living at the territories of Kaluga district contaminated with radionuclides
Matveyenko Y.G., Gorobets V.F., Vtyurin B.M., Parshin V.S., Oleinik N.A., Rumyantsev P.O., Leshakov S.Y., Borovikova M.P.
Abstract

Thyroid status of children and adolescents living in the Kaluga district at territories contaminated with radionuclides after the Chernobyl accident was followed up from 1986 to 1994. Clinical studies included examination by endocrinologist, ultrasonic examination of the thyroid and regional lymph nodes with fine needle aspiration biopsy of thyroid tissue, if indicated, and measurements of blood serum levels of thyrotropin, thyroxin, triiodothyronine, thyroglobulin and autoantibodies to it, and of antibodies to the microsomal fraction of thyrocytes. Special attention was paid to the detection of nodular formations in the thyroid and identification of their type. The diagnoses were verified at Medical Radiology Research Center of the Russian Academy of Medical Sciences in the town of Obninsk. In 1994 an increase in the incidence of nodular goiter was observed in the cohort of children followed up. Four cases of thyroid cancer (follicular and papillary forms) were diagnosed in 1993-1994 among subjects exposed to radioactive iodine in childhood after the accident. Three of these patients were examined and treated at the Medical Radiology Research Center. Detailed excerpts from their case histories are presented.

Problems of Endocrinology. 1996;42(5):23-26
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Clinical and cytogenetic correlations in mixed gonadal dysgenesis
Kasatkina E.P., Kozlova S.I., Prytkov A.N., Tarskaya L.A., Patyutko R.S., Lelikova G.P.
Abstract

Clinical-karyotypical correlations have been analyzed in 36 patients with mixed gonadal dysgenesis. The minimal diagnostic signs have been determined: rudimentary uterus, uterine tube, split scrotum, perineal hypospadias, left streak gonad, testicular hypoplasia and scrotal localization of the testicle, and the most incident concomitant abnormalities. A comparative analysis of the distribution of signs in groups with different karyotype disorders has been carried out. The authors discuss the clinical variability of this abnormality on the basis of genetic approaches to the study of mixed gonadal dysgenesis.

Problems of Endocrinology. 1996;42(5):26-30
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Andriol and Sustanon-250, a testosterone preparation, in the therapy of androgen deficiencies
Kozlov G.I., Slonimsky B.Y.
Abstract

Oral andriol is compared with long-acting testosterone drug Sustanon-250. Testosterone and LH values normalized in patients with primary hypogonadism in the course of therapy. Andriol was effective in the patients with pronounced androgen deficiency, which manifested by increased libido, spontaneous and adequate erections, and stabilization of the frequency of coitus. Andriol in doses of 80 to 120 mg/day creates stable concentrations of testosterone in the blood plasms, this level corresponding to the lower threshold in health.

Problems of Endocrinology. 1996;42(5):30-32
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Guidelines for patients with the hypothalamo-pituitary disorders; School for patients
Melnichenko G.A., Romantsova T.I., Chernogolov V.A., Pavlova M.G.
Abstract

In the previous issue, we talked about the structure and functions of the hypothalamic-pituitary system, as well as the need to create schools to help patients with hypothalamic-pituitary disorders. Today we want to focus on the manifestations of pituitary hormone deficiency and the basic principles of treatment of this pathology. Lack of pituitary hormones If the pituitary gland does not produce certain hormones or produces them in small quantities, then this condition is called hypopituitarism. Most often, this condition occurs due to the presence of a benign (i.e., non-cancerous) tumor of the pituitary gland or hypothalamus. If a person has a pituitary tumor, it can lead to a decrease in its functions by direct pressure of the tumor mass on the healthy part of the pituitary gland or as a result of surgical treatment or irradiation of the tumor. Less commonly, hypopituitarism is caused by infectious diseases of the brain (such as meningitis), significant blood loss (for example, during childbirth), head injuries, as well as rare diseases (sarcoidosis, etc.). I. Lack of ACTH. 1. What are the symptoms of ACTH deficiency? The most common symptom is fatigue, a feeling of general weakness, sometimes dizziness. Some patients have nausea and diarrhea.

Problems of Endocrinology. 1996;42(5):32-33
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Experimental endocrinology
Study of human thyroglobulin gene polymorphism
Kadyrova D.A., Atakhanova B.A., Rakhimova M.L., Umarova G.D., Turakulov Y.K.
Abstract

The main goal of this work was to conduct a population genetic analysis of RFLP detected in the TG gene and to develop a system of molecular genetic studies of hereditary thyroid diseases associated with polynucleotide rearrangements in the structure of TG. A population genetic analysis of RFLP detected in the TG gene was carried out. When splitting blood samples of healthy Tashkent residents with EcoRV and Taql restriction enzymes, 2 pairs of alternative variants of normal RFLP were detected - 13.8 or 8.5 and 5.8 or 6.2 bp respectively. In order to detect RFLP in the TG gene for congenital hypothyroidism, DNA samples from 2 families (mother, father, daughter) with a clinical diagnosis of congenital hypothyroidism were analyzed and the same variants of RFLP found in healthy individuals.

Problems of Endocrinology. 1996;42(5):34-36
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Characterization of pancreatic b-cell receptors binding sulfanilamides under conditions of experimental diabetes mellitus
Babichev V.N., Savelyeva I.P., Balabolkin M.I.
Abstract

The receptor properties of pancreatic b-cells functionally attenuated under the effect of streptozotocin during therapy with sulfanilamides widely used in diabetes mellitus (glibenclamide, glipizide, and gliclazide) were studied. These drugs were shown to be characterized by the high capacity to specifically bind to receptors, which virtually do not differ from those of intact b-cells. The receptors were characterized by two parameters: the number of binding sites and dissociation constant. Glibenclamide has demonstrated high binding capacity. The binding of these agents was reversible. The authors do not identify the studied receptors of sulfanilamides with the K+-ATP channels which are also known as the active conductors of the information carried by sulfanilamides in the mechanism of insulin secretion.

Problems of Endocrinology. 1996;42(5):37-39
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Reviews
Experimental and Clinical Aspects of using luteinizing hormone-releasing factor and its analogs
Nizharadze I.A.
Abstract

This literature review briefly summarizes the methods of application and the conditions necessary from the physiological point of view to activate the secretion of gonadotropins by the pituitary gland by stimulating the luteinizing hormone-releasing hormone (LH-RH) in a pulsating mode, and we compare the effect of the pituitary stimulating LH-RH- agonists. The structure of LT-RG was explained in 1971 by Matsuo, Baba, in 1972 by F. Burgus, J. Butcher and confirmed in 1971 by the synthesis of Geiger, Konigi Wissmann. Studies conducted over 10 years showed that LG-RG , as well as its analogs are important for clinical practice. There are 2 active groups of agonist analogs. The 1st includes LH-RH analogs with an altered amino acid sequence and is abbreviated Trp "LH-RH. These peptides have a structure very similar to the natural LH-RH. The 2nd group combines LH-RH of 1-9-nano-peptidethylamide agonists. These peptides differ from LH-RG in their C-terminal sequence, Pro9-ethylamide, Leu6 is introduced - LH-RH (l-9-ethylamide), which is abbreviated as Leu6-EA- (1-Trp6), LH-RH (1-9 -ethylamide) - abbreviated as Trp-EA-Z-Ser (Bu +) 6, LH-RH 1-9-ethylamide - l-Ser- (Bu +) 6-EA.

Problems of Endocrinology. 1996;42(5):40-42
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On the contribution of immune 42 mechanisms to the pathogenesis of diabetic nephropathy
Kamayeva О.I., Sura V.V.
Abstract

Diabetic nephropathy (NF) came first among all the specified causes of end-stage renal failure. Patients with type 1 diabetes mellitus (DM) make up more than half of all patients treated with chronic hemodialysis in the United States and Western Europe. Among patients with diabetes with terminal renal failure, 60% are people over 50 years old, so hemodialysis is not always prescribed. However, hemodialysis is increasingly used in elderly and senile patients; therefore, the proportion of patients with diabetes, especially type II diabetes, in hemodialysis centers will increase, significantly increasing the cost of treating diabetes. Currently, along with metabolic, hemodynamic and genetic theories, the role of immune disorders in the formation and progression of DNs is being discussed. The prerequisites for the formation of a hypothesis about the immune genesis of DNs were the frequent detection of increased levels of circulating immune complexes (CICs) and immunoglobulins in the blood, as well as deposits of immunoglobulins and complement in the kidney structures of patients with diabetes. However, among researchers there is no unanimity in the explanation of these facts. Many consider indisputably existing immune abnormalities inherent in DN as non-specific epiphenomes. The immune hypothesis of the pathogenesis of DN was formulated back in the 70s. The currently accumulated data suggest the participation of the immunocomplex mechanism in the development of DN. Immunofluorescence examination of the kidney tissue of patients with diabetes almost always reveals a luminescence of IgG, IgM, less often IgA, SZ and other complement fractions along the basal membranes of the glomeruli (BMC) and tubules of focal granular and linear in nature.

Problems of Endocrinology. 1996;42(5):42-47
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