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Vol 49, No 1 (2003)

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Clinical endocrinology
Magnetic resonance imaging of the hypothalamopituitary area in the diagnosis of neurogenic diabetes insipidus
Dedov I.I., Vorontsov A.V., Vaks V.V., Marova Y.I., Averkiyeva Y.V., Vladimirova V.P.

Fifty two patients (23 males and 29 females) with neurogenic diabetes insipidus (DI) were examined to define the role and specific features of brain magnetic resonance imaging (MRI) in the diagnosis of hypothalamopituitary abnormalities in this disease retrospectively after establishing the diagnosis. The group understudy included patients who had symptoms of only DI (they had no signs of chiasm or hypopituitarism). The fol­lowing abnormalities were detected: no hyperintensive signal of the neurohypophysis body on T1-weighed images in 42.3%) of patients, bulky chiasmocellar masses in 13.6%), the empty ephippium in 15.3%), its structural abnormalities in 1.9%). Ab­normal MRI scans were absent in 26.9% of patients with neu­rogenic DI. Since DI may be the first and only symptom of hy­pothalamopituitary tumor lesion, a sensitive topical technicjue, such as MRI, should be applied. It was found that brain MRI revealed no hyperintensive signal from the neurohypophysis body on T1-weighed images in 61%) of the patients with idi­opathic DI, which may be a pathognomonic sign of idiopathic DI.

Problems of Endocrinology. 2003;49(1):3-7
Chronic gastroduodenal ulcers in patients with diabetes mellitus
Fedorchenko Y.L.

The clinical picture, course, and treatment of gastroduodenal ul­cers (GDU) in diabetics were studied. A total of 395 diabetics were examined; GDU were detected in 36. The incidence of gas­tric and duodenal ulcers was similar in patients with insulin-de­pendent diabetes mellitus, while in patients with non-insulin-de- pendent diabetes gastric ulcers predominated. The clinical pic­ture of the disease, gastric acid production, Helicobacter pylori infection, and blood gastrin levels were studied in all patients with ulcers. The efficiency of GDU treatment with quamatel, raniti­dine, and antacids was evaluated. The clinical course of GDU in diabetics was asymptomatic. The highest incidence of H. pylori, infection was observed in patients with type 1 diabetes with con­comitant peptic ulcers. Serum gastrin levels were more frequently increased in patients with type 1 diabetes and duodenal ulcers and normal in patients with type 2 diabetes. Quamatel therapy was highly effective in diabetics with GDU. Ulcers healed in 85% patients and blood gastrin level significantly decreased after 3- week therapy. GDU in diabetics are characterized by specific lo­cation, clinical course, laboratory and instrumental features, which allows a differentiated approach to therapy of these pa­tients.

Problems of Endocrinology. 2003;49(1):7-12
The left ventricular myocardium in children at early stages of diabetes mellitus: Functional and morphometric parameters
Kuznetsova I.G., Filaretova О.V., Nastausheva T.L., Stolnikova T.G., Zazulina О.V.

Its morphometric parameters (myocardial mass according to the procedure described by R. Devereuxe, end-diastolic volume and their ratio). Sixteen healthy children of the same age formed the control group. A gradual redistribution of transmitral flow to­wards the atrial systolic phase was found in children with a more than 5-year history of diabetes, which seems to be associated im­paired L V myocardial relaxation due to myocardial metabolic changes and to the occurrence of specific microangiopathies. The found changes progressed with time and correlated with the ap­pearance ofperipheral distal neuropathy. Within the first year of diabetes, there was a transient reduction in LV contractility, which appears to be associated with myocardial metabolic im­balance during the decompensation of the disease. There is a trend to LV myocardial hypertrophy 10years after the onset of the disease.

Problems of Endocrinology. 2003;49(1):12-16
Paraoxonase activity and lipid peroxidation in female patients with type 2 diabetes mellitus and without coronary heart disease
Gorshunskaya. M.Y.

The rate of lipid peroxidation and the parameters of antioxida- tive defense, including the activity of paraoxonase that is essen­tial for the prevention of low-density lipoprotein oxidation, was studied in 229 female patients with type 2 diabetes mellitus with and without coronary heart disease (CHD) under varying glyc­emic control. Carbohydrate and lipid metabolisms were explored by unified biochemical studies, blood insulin levels were meas­ured by radioimmunological assay. The activity of paraoxonase associated with high-density lipoproteins of ester hydrolase was spectrophotometrically determined by using paraoxan as a sub­strate. Along with dyslipoproteinemia and insulin resistance, there was a drastically reduced paraoxonase activity that was as­sociated with the high-density lipoproteins of the antioxidant en­zyme and more pronounced in diabetics with CHD. A highly sig­nificant inverse correlation of the activity of the enzyme with the rate of lipid peroxidation and a less close relationship to basal glycemia have been verified, which substantiates the polygenic nature of decreased paraoxonase activity in diabetes mellitus.

Problems of Endocrinology. 2003;49(1):16-19
Clinical and morphological features of reparative processes in patients with the diabetic foot syndrome
Udovichenko. О.V., Tokmakova A.Y., Antsiferov M.B., Yushkov P.V., Dedov I.I.

The purpose of the study was to examine structural abnormalities in the skin and granulation tissue, which explain long-term heal­ing and recurrent trophic ulcers in patients with the neuropathic diabetic foot syndrome who received adequate treatment. Biopsy specimens were taken from the granulation tissue and skin of the edge of a trophic ulcer in 12 patients (mean age 48.4±6.6 years) with types 1 and 2 diabetes mellitus (its duration was 14.0±4. 7 years). All the patients were treated for the neuropathic diabetic foot syndrome according to the generally accepted recommenda­tions. According to the duration of trophic ulcer, the patients were divided into 2 groups: 1) 4 patients with a history of under 3 months and 2) 8 patients with a history of above 3 months. Ac­cording to the presence or absence of trophic ulcers in the history, all the patients were again divided into Groups A (recurrent ul­cers, n = 5) and В (primary ulcers, n = 7). Patients with slowly healing ulcers were found to have an abnormal foot pressure more frequently, as evidenced by computerized pedography (the peak load in the ulcer area being in 63% of them versus 25% in Group 1) and some specific features of granulation tissue (excess of active fibroblasts, immaturity of the extracellular matrix, at­rophy and sclerosis of nerve fibers). Patients with recurrent ulcers were older, demonstrated lower vibration perception scores, mor­phological features, such as abundant active polymorphonuclear leukocytes, mast cells with signs of degranulation and T-helper cells, immature extracellular matrix, fibrinoid necrosis and young capillary vessels with microthrombi. Thus, the detection of the above granulation tissue and wound edge changes (especially with an abnormal foot pressure pattern, significantly low vibra­tion perception scale, and old age) makes it possible to suggest slow healing or recurrence of ulcer.

Problems of Endocrinology. 2003;49(1):19-24
Impact of hypolipidemic therapy on carbohydrate and lipid metabolism and their hormonal regulators in patients with type 2 diabetes mellitus
Starkova N.T., Dolgov V.V., Davydov A.L., Roitman A.P., Baranova L.Y., Trubnikova T.Y., Sazhin N.L.

The effects of lipostat and maninil on carbohydrate and lipid metabolisms and their hormonal regulators were studied in 36 obese patients aged 50- 70 years who had type 2 diabetes mellitus concurrent with dyslipidemia. A course of therapy with lipostat in a daily dose of 20 mg for 3 months was shown to lead to nor­malization of lipid metabolism, to diminished glycemia and hyperinsulinemia, and to an increase in fasting plasma somatotrop­ic hormone levels to normal values, these were not observed in the control group.

Problems of Endocrinology. 2003;49(1):24-26
Problems in the diagnosis of the adrenals with incidental
Kuznetsov N.S., Belchenko L.V., Yushkov P.V., Manovitskaya A.V., Opalenov К.V., Mamayeva V.G.

The paper analyzes the case records of 123 patients with a primary diagnosis ofadrenal incidentaloma who were treated at the Endocrinology Research Center, Russian Academy of Medical Sciences, in the past 5 years. Ofthem, 87patients were operated on at the surgical department of the Center. Thirty  six patients with a clinically verified diagnosis ofhormonally inactive adrenal tumor without signs ofmalignant growth werefollowed up. All the patients underwent comprehensive clinical and instrumental studies (ultrasonography, magnetic resonance imaging, computed tomography, hormonalstudies). Theirresults were comparedwith the morphological data on distal adrenal changes. The hormonal activity ofadrenal tumors was morphologically determined by histochemical techniques. The study revealed true hormonally inactive tumors only in 12 cases. It is concluded that the concepts of adrenal incidentaloma and of true hormonally tumor are not equivalent and that it is necessary to make a comprehensive clinical and morphobiochemical analysis in adrenal tumors to establish a final nosological diagnosis.

Problems of Endocrinology. 2003;49(1):26-31
Magnetic resonance imaging in the diagnosis of hypothalamopituitary diseases in patients with true premature sexual development
Vorontsov A.V., Semicheva T.V., Peterkova V.A.

То evaluate the incidence of different types of organic abnormal­ities occurring in premature sexual development (PSD) of central genesis and to study a role of magnetic resonance imaging (MRI) in the diagnosis of PSD, MRI was used in 33 patients with a clin­ically established diagnosis of true (gonadotropin-dependent) PSD of central genesis. Among the examined children with PSD, hypothalamic hamartoma was detected in 27.3%) of the patients; there were no MRI data suggesting hypothalamopituitary abnor­malities in 72.7%o. On the MRI images, a hypothalamic hamar­toma appeared as a round or oval mass having a well -defined outlines, a homogeneous structure, 3 to 15 mm in size, which is located in the projection of mamillary bodies or retrochiasmally. Patients with PSD were found to have an increased volume of the adenohypophysis mainly due to the vertical size as compared with a group of healthy children of the same age.

Problems of Endocrinology. 2003;49(1):32-36
Complete elimination of iodine deficiency-induced diseases in the Republic of Serbia through overall salt iodination
Simic M., Banisevic M., Andjelkovic Z., Zivic G., Zikic L., Beloglav D., Simic D., Gerasimov G.A., Mishchenko B.

The territory of Serbia has been long known to be an iodine de­ficiency area. The surveys conducted in the past 50 years have shown that iodine deficiency disorders ranged from small goiters to endemic cretinism. The iodine deficiency control program has been implemented in Serbia since 1951, in so doing, the salt con­centration of iodine (as potassium iodide) has been gradually in­creased and at present it is 20 mg/kg. Just in the mid- 1960s, io­dine prophylaxis led to cessation of new cases of cretinism and large goiters.This survey was undertaken to determine the iodine provision in Serbia. The survey was conducted in accordance with the WHO, UNICEF, and ICCIDD guidelines and it covered 4598 school­children aged 7 to 15 years from the urban and rural areas of 44 municipalities of Central Serbia and Vojvodina. Among all the examinees, the detection rate of the enlarged thyroid was 2.35% (as evidenced by ultrasound study) and the median urinary io­dine concentration was 158 μg/l. The findings suggest that iodine deficiency has been completely eliminated in Serbia due to the ef­fective program of the overall dietary salt iodination.

Problems of Endocrinology. 2003;49(1):37-40
Chorionic gonadotropin regulation of intracellular potassium levels in human blood immunocompetent cells; a role of phases of a menstrual cycle
Shirshev S.V., Lyalina O.G.

The effect of chorionic gonadotropin (CG) on intracellular po­tassium ion( [K+]i) levels in human blood immunocompetent cells was studied by taking into account the phases of a menstrual cy­cle. CG was used in doses of 10, 50, and 100 IU/ml. Plasma photometry was used to measure the level of [K+]i in the frac­tionated peripheral monocytes and lymphocytes from males, as well as from females in the late follicular and luteal phases of a menstrual cycle. CG used in a dose of 100 IU/ml was found to lower flCf in the monocytes and lymphocytes of males and in a dose of 50 IU in the lymphocytes of females in the luteal phase of a menstrual cycle. The hormone used in large doses stabilized the level of [K+]i in both types of cell of female in the follicular phase. It is concluded that CG can modulate the level of [K+]i in human peripheral blood immunocompetent cells, and the direc­tionality of its effects depends on a type of hormone-accepting cells and it is determined by a menstrual phase.

Problems of Endocrinology. 2003;49(1):41-44
For practitioners
Forty-year experience in diagnosing and treating chromaffine tissue tumors
Dedov I.I., Kuznetsov N.S., Beltsevich D.G., Kuratev L.V.

The article devoted to the forty-year experience in diagnosing and treating chromaffine tissue tumors

Problems of Endocrinology. 2003;49(1):44-50
Experimental endocrinology
Neurophysiological effects of corticotropin-releasing factor in the undergoing sections of the olfactory area of the rat cerebral cortex
Mokrushin A.A., Shalyapina V.G.

Application of corticotrophin-releasing factor (CPF) in concen­trations of 10-9-10-8 M on the rat olfactory cortex slices induced activation of the pre- and postsynaptic excitatory components of the focal potentials recorded in the slices. The amplitude and du­ration of α-amino-3-hydroxy-5-methyl-isoxazole-4-propionic and N-methyl-D-aspartate components of postsynaptic evoking potentials increased upon exposure to CRF, while the amplitude of GABAB-mediated inhibitory postsynaptic potentials was sup­pressed. At higher concentrations of CRF (10-8 M) epileptiform charges were recorded in the cells. CRF effects were reversible and eliminated after washing. A long (90 min) exposure induced the phenomena similar to long-term posttetanic potentiation. The findings suggest that CRF has pronounced activating properties and ajfects the glutamatergic and GABAergic systems.

Problems of Endocrinology. 2003;49(1):51-53
Endocrine and messenger systems during adaptation to high-altitude conditions
Vishnevsky A.A., Zakirov D.Z., Yakovlev V.M., Zholdubayeva L.Y., Zakharov G.A.

Of endocrine cascades and messenger systems, the authors con­ducted this study involving two series of experiments. The pattern of interaction of hormones and secondary messengers while adapting to high-altitude was clarified in the first series. The re­sponse of phosphoinositide to exogenous epinephrine was exam­ined in the second series. The experimental data are represented as primary mean values ± standard deviations. Two phases of activity of the hormonal system are shown. These are the exci­tation of the hypothalamopituitary cascade and the enhanced production of glucocorticoids and catecholamines during early adaptation and the return of activity of the hormonal system to the baseline values by day 14 of adaptation. By that time the re­arrangements in the phosphoinositide messenger system consists in increasing the proportion of polyphosphoinositides in the total membranous fraction of inositol-containing phospholipids, in adrenalectomized animals to a greater extent. The above events give rise to new coordination relations between hormones and secondary messengers. It is concluded that that the phosphoi­nositide messenger system is involved in the formation of defense mechanisms the reduce the destructive effects of large amounts of epinephrine.

Problems of Endocrinology. 2003;49(1):53-56
In memory of A. M. Granovsky-Tsvetkova

The necrology devoted to the memory of A. M. Granovsky-Tsvetkova

Problems of Endocrinology. 2003;49(1):56-56

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