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Vol 50, No 3 (2004)

Clinical endocrinology
The internal picture of the disease in type 1 diabetes
Sidorov P.I., Novikova I.A., Solov'ev A.G., Mul'kova N.N.

То study the internal picture of the disease, 73 patients with type 1 diabetes mellitus (DM) were examined. Among them, there were 43 females and 31 males whose age was 14 to 60 years and whose disease duration was 6 months to 39years. Psychological diagnostic tests evaluating their attitude to the disease revealed that in the patients, hypo- and hypernosognosias were prevalent in the pattern of nosognosias, hyponosognosias being observed somewhat more frequently, and adequate reactions to the disease were observed rel­atively rarely (15%). Among hyponosognosias, there was most commonly an ergopathic or anosognosic type of an attitude to the disease, which leads to the underestimation of their disease and to poor metabolic control. Hypemosognosia was more characteristic for females, which in the presence of severe complications and with a long-term history of the diseases is a consequence of DM complications and premorbid personality traits. A sensitive type as a result of social disadaptation and discrimination of society towards DM patients holds a central position in the pattern of hypernosognosias.

Obligatory psychological and psychotherapeutic correction of the internal picture of disease in DM is required to achieve good pa­rameters of metabolic control and qualitative management of DM, which will promote the patients’ better life quality.

Problems of Endocrinology. 2004;50(3):3-6
The value of the simultaneous determination of content glycated proteins and antibodies to islet cells in children and adolescents
Aikhodzhaeva M.A., Rakhimova G.N., Akbarov Z.S., Zalyalieva M.V., Akhmedova S.U.

An assessment was made of the potentiality of identification of individuals at risk for type 1 diabetes mellitus (DM) among children with transient hyperglycemia by simultaneously determining the levels of antibodies to pancreatic islet cell antigens (ICA) and insulin antigen (IA), as well as glycated proteins of different life span.

The content of antibodies to ICA and IA was measured in 76 children and adolescents aged 3 to 20 years who had a history of transient hyperglycemia and in 18 children of the same age who had DM-characteristic complaints. They also underwent a glucose tolerance test and the levels of glycated hemoglobin (HbAlc), glycated hair keratin (GHK), and glycated fibrinogen (GF) were de­termined.

The children with a history of transient hyperglycemia, those with impaired glucose tolerance, and a group of individuals with fasting glycemic disturbances were found to have higher levels of glycated proteins (GHK and HbAlc) and a significantly more frequency of and higher titers of antibodies to IS and ICA than in the children from the control group and in those without carbohydrate metabolic disturbances.

Problems of Endocrinology. 2004;50(3):6-9
Screening Results for Type 2 Diabetes in the Udmurt Republic
Trusov V.V., Marizin S.A., Shmykova N.E., Aksenov K.V.

The study was undertaken to reveal the prevalence of type 2 diabetes mellitus and impaired glycose tolerance among the Udmurt Republic ’s employed population that has risk factors of diabetes mellitus. A total of 7137 employed individuals were examined in the organized working collective bodies in the Udmurt Republic by the routine program. Among the examinees, there were 238 patients first diagnosed as having type 2 diabetes mellitus (3.33% of all the examinees) and 184 patients with impaired glucose tolerance (2.58% of all the examinees). Thus, the screening survey conducted among the employed of the Udmurt Republic indicated the high clinical efficiency of early detection of disease, which made it possible to timely define and implement a package of prophylactic and therapeutic measures for diabetes mellitus complications. This determines the economic expediency of performing a screening survey for diabetes mellitus, which permits the saving of material resources to be spent for treating the late diagnosed complications of diabetes.

Problems of Endocrinology. 2004;50(3):10-12
Antibodies to islet tissue of the pancreas in patients with hormone-dependent tumors
Bershtein L.M., Vartanyan N.L., Vasil'ev D.A., Gamayunova V.B.

Islet b-cell antibodies (ICA) were studied by immune fluorescence test in the blood serum of total of 192 individuals. Blood was sampled after previously nocturnal starving in 22 cancer patients with evident type 2 diabetes mellitus (DM2) (in those mainly with cancer of the breast (BC) and corpus uteri (CUC)), in 124 patients without diabetes (55 patients with BC and 69 patients with CUC), and in 41 healthy individuals. The study revealed ICA in 13.6% of the patients with hormone-dependent tumors and DM2, in 8.3% of the patients with BC and CUC and impaired glucose tolerance, in 6.6% of the patients with normal tolerance, ICA were absent in the healthy individuals (a comparison group). The detection of ICA in patients without signs of DM2 was associated with weight gain, the trend towards hypertriglyceridemia and transient hyperinsulinemia, with the elevated blood concentrations of thy­roglobulin and its antibodies. It is concluded that autoimmune disturbances of this kind are peculiar not only to patients with MD1 and, in their combination in persons aged above 40-50 years with a complex of hormone-dependent metabolic disturbances appeared as insulin-resistance syndrome should be regarded as an object for preventive measures in diabetology and oncoendocrinology.

Problems of Endocrinology. 2004;50(3):13-15
Assessment of improving the quality of life of patients with metabolic syndrome
Antyuf'ev V.F., Kodolova Y.V.

The stationary technique for examining and treating patients with the metabolic syndrome who had vascular diseases of the heart and brain was tested in the regional rehabilitative center "Ozero Chusovskoye" (Chusovsk Lake), Yekaterinburg. The purpose of the study was to examine the pattern of metabolic and cardiovascular disorders in relation to the severity of obesity and to assess the results of their correction 6 months after the initiation of adequately chosen therapy. The results of 6-month multimodality treatment for the metabolic syndrome, which involved both drug and non-drug methods, such as reduction in body weight and its index by 8.5 and 19.86%, respectively, in the proportion offat in the body by 9%, a significant decrease in the blood level of sugar 2 hours after load, hepatic transaminases, uric acid are presented. A significant relationship was found between the degree of obesity and the severity of cardiovascular and metabolic disorders.

Problems of Endocrinology. 2004;50(3):16-21
Differential diagnosis of constitutional delay of puberty and hypogonadotropic hypogonadism in boys
Semicheva T.V., Bakanova T.D.

Retarded puberty represents по signs of sexual development in adolescents. This study was undertaken to examine clinical criteria for diagnosing constitutional puberty retardation and hypogonadotropic hypogonadism and to evaluate the diagnostic value of a test using the synthetic analogue of daily action LH-RH busereline in the differential diagnosis of these conditions. Fifty-two male ado­lescents aged 13.5 to 15.5 years who had no clinical and hormonal signs of the onset of pubescence; 5 of these patients had anosmia, which suggested that they had the Kallmann syndrome (secondary hypogonadism). All the patients had a stimulation test using buser­eline. In 7patients (Group 1), including 5 with anosmia, the maximum elevation of the level of luteinizing hormone (LH) in response to stimulation was less than the puberty value (< 8 U/l). In the remaining 45 adolescents, the maximum elevation of LH reached puberty values and ranged from 11.2 to 50.1 U/l, which made it possible to diagnose transient retarded puberty in them (Group 2). All the patients were followed up for 1-3 years. During this period, there was progressive puberty in all the patients of Group 2 and no intrinsic puberty in Group 1 patients. The findings showed the informative value of the test using the long-acting LH-RH analogue busereline for the differential diagnosis of constitutional puberty retardation and secondary hypogonadism in adolescents.

Problems of Endocrinology. 2004;50(3):21-24
Urokinase and tissue plasminogen activators and their inhibitor for thyroid diseases
Kushlinskii N.E., Kazantseva I.A., Gershtein E.S., Kharitidi T.Y., Lyakina L.T.

The results of a comparative study of the level of the components of the plasminogen activation system - и Pa, tPA, and PAI-1 in the tissues of cancer and benign masses of the thyroid are presented. Nineteen patients with nodal colloidal goiter (NCG) with adeno­matosis, 43 patients with NCG without adenomatosis, 9patients with diffuse toxic goiter (DTG) with adenomatosis, 13 patients without adenomatosis, 18 patients with thyroid adenoma (TA), and 44 patients with thyroid cancer (TC) were examined. The concentrations of the studied proteins were determined by enzyme immunoassay in tissue cytosols. The lowest levels of tPA and the highest values of и PA and PAI-1 were found in the tumors of patients with TC whereas the high values of tPA and the relatively low levels of и PA were typical of benign thyroid hyperplasias and TA. The lowest levels of PAI-1 were detected in patients both with and without DTG. The tissue level of the components of the plasminogen activation system in TC did not virtually depend on the histological features of a tumor, but it significantly correlated with the extent of a process.

Problems of Endocrinology. 2004;50(3):25-29
Production of some cytokines in patients with autoimmune thyroid disease
Glazanova T.V., Bubnova L.N., Trunin E.M., Kuzmichev A.S., Pavlova I.E.

Imbalance ofproinflammatory and anti-inflammatory cytokines makes a considerable contribution to the pathogenesis of autoimmune diseases, including those of the thyroid. The specific features ofperipheral mononuclear cell production of anti-inflammatory cytokines (TNF-a, IL-1(3, and IL-6), the level of the anti-inflammatory cytokine IL-10 in the serum and the serum level of autoantibodies to thyroglobulin were studied by enzyme immunoassay in 20 patients with histologically verified diffuse toxic goiter (DTG) and in 18 patients with autoimmune thyroiditis (AIT). Both in DTG and AIT, there was a significant enhancement of the capacity of peripheral blood cells to the spontaneous production of proinflammatory cytokines (TNF-a, IL-1(3, and IL-6), which is indicative of preexisting cell activation; their diminished capacity to respond to an inductor in vitro, which reflects an in vivo potential response to antigenic stimulation; as well as increased IL-10 synthesis. More pronounced impairments of cytokine-producing capacity were observed along with the more active formation of autoantibodies to thyroglobulin in patients with AIT.

Problems of Endocrinology. 2004;50(3):29-32
Case Reports
Idiopathic hypoparathyroidism with epilepsy, optic atrophy and the syndrome of the "empty" Turkish saddle
Bondar' I.A., Klimentov V.V., Sorogina L.D.

Hypoparathyroidism is an endocrine disease caused by decreased secretion or action of parathyroid hormone (PTH). In the vast majority of cases, clinicians experience hypoparathyroidism resulting from damage or removal of the parathyroid glands during surgical interventions.

Problems of Endocrinology. 2004;50(3):32-34
Experimental endocrinology
Expression of 5’-deiodinase in various thyroid tumors
Artykbaeva G.M., Turakulov Y.K.

5'-deiodination is an important pathway for the metabolism of T4 by determining its great role as a prohormone for T3. T4 is metabolized by two 5'-deiodinases: DI and DII which are encoded by different genes, regulated by different modes and expressed in various tissues. The aim of the present study was to examine DI and DII expression in health and in various human thyroid tumors. Eighteen thyroid specimens (10 from tumors and 8 from the intact thyroid tissues surrounding the nodes) were used. RNA isolated from the tissues by reserve transcription, followed by polymerase chain reaction (PCR) were transcribed to cDNA. Gel electrophoresis showed the bands corresponding to 177 b. p for DI and 796 b. p for DII. The experiments demonstrated that there were genes of both isoenzymes of 5 ’deiodinases in thyroid carcinoma tissues. Gel electrophoresis indicated the different expression of PCR products in different thyroid tumors for DI and DII at the level of mRNA.

Problems of Endocrinology. 2004;50(3):34-37
The effect of multiple injections of cholecystokinin 26-33 on a- and p-cells of islets of Langerhans normal and in experimental type 1 diabetes mellitus
Orlovskii M.A., Kolesnik Y.M., Abramov A.V.

The impact of multiple peripheral (intraperitoneal) and central (intracerebroventricular) administrations of cholecystokinin 26-33 (CCK-8) octapeptide on the function of a- and /3- cells of the islets of Langerhans was studied in investigations made on normal rats and rats with experimental streptosotocine-induced type 1 diabetes mellitus. Insulin in /З-cells and glucagon in а-cells were found by indirect immunofluorescence. Both routes of administration to normal animals were shown to lead to the suppressed secretion of insulin with decreased food intake. At the same time the central administration of CCK-8, unlike the peripheral one, caused a sig­nificant (p < 0.05) rise in the level of glycemia and enhanced glucagon production in а-cells, while the administrations of the peptide to diabetic animals resulted a significant increase in the blood concentration of insulin (p < 0.05), to the lower level of glycemia (p < 0.05) and to suppressed polyphagia (p < 0.01), which is associated with the activation of /З-cell function and with the suppression of the pathologically high activity of а-cells. The established facts suggest that neuroendocrine interactions are impaired in diabetes mellitus and confirm the previously made suggestions that cholecystokinin plays an important role in the pathogenesis of this disease.

Problems of Endocrinology. 2004;50(3):37-41
Radiation therapy in the treatment of pituitary adenomas
Marova E.I., Bel'chenko L.V., Manchenko O.V., Kirpatovskaya L.E.

Over the nearly century-long history of radiation therapy, tremendous clinical experience has been accumulated, based on ideas from experimental and clinical radiobiology. The use of ionizing radiation energy for therapeutic purposes was the key to the successful treatment of a number of neuroendocrine diseases of tumor origin.

Problems of Endocrinology. 2004;50(3):41-48
Disorders of lipid metabolism in subclinical hypothyroidism
Sych Y.P., Fadeev V.V., Mel'nichenko G.A., Syrkin A.L., Roitman A.P.

Subclinical hypothyroidism (SG) is a syndrome caused by a persistent borderline decrease in the level of thyroid hormones in the body, in which a normal level of T4 is determined in combination with a moderately elevated level of TSH. SG is the most common thyroid dysfunction.

Problems of Endocrinology. 2004;50(3):48-52
Efimov A.S. (on the occasion of the 75th birthday)

November 10, 2003 marks the 75th anniversary of the academician of the NAS and the Academy of Medical Sciences of Ukraine, RAMS, professor Andrei Semenovich Efimov

Problems of Endocrinology. 2004;50(3):53-54
V.V. Potemkin (on the occasion of his 70th birthday)

70 years have passed since the birth and 46 years of scientific and pedagogical and medical activity of one of the leading endocrinologists in our country, the founder of university endocrinology, the founder and first head of the endocrinology department of the Russian State Medical University (RSMU), Honored Doctor of the Russian Federation, Professor Vladimir Potemkin .

Problems of Endocrinology. 2004;50(3):54-54

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