Vol 53, No 5 (2007)

Clinical endocrinology
Early renal changes in type 1 diabetes
Bondar I.A., Klimontov V.V., Nadeyev A.P., Bgatova N.P.

The relationships between renal structural abnormalities, metabolic, and hemodynamic changes were studied in 35 type diabetic patients with normal creatinine clearance. Sixteen patients had normal urinary albumin excretion (UAE) rates, 17 were microalbuminuric and 2 had proteinuria (0.68 and 0.8 g/day). Light and electron microscopy revealed the early stages of diffuse glomerulosclerosis, tubular dystrophy and atrophy, intestinal and arteriolar sclerosis in the renal biopsy specimens of the examinees. Increased UAE was associated with the reduced percent of glomerular podocytes, the thickening and fusion of small podocytic processes, the increased thickness of the glomerular and tubular basement membrane, the reduced number of endothelial fenestrae, the increased fractional volume of the mesangium, perioglomerular sclerosis, global sclerosis of some glomeruli, tubular endothelial atrophy, and intestinal and arteriolar sclerosis. Clycemic control, diabetes duration, albumin excretion rate, and blood pressure are the predictors of early renal structural changes.

Problems of Endocrinology. 2007;53(5):3-8
A system for preventing lower limb amputations in patients with diabetes and prospects for its introduction in Moscow
Antsiferov M.В., Komelyagina E.Y., Volkovoy A.K., Myskina N.A.

We initiated the implementation of a program for the prevention of lower limb amputations in patients with diabetes in Moscow. The long-term goal of this project is to carry out specialized treatment and preventive measures based on diabetic foot cabinets, aimed at reducing the number of lower limb amputations in patients with diabetes mellitus, who are at risk of developing diabetic foot syndrome.

Problems of Endocrinology. 2007;53(5):8-12
Familial type of nephrogenic diabetes insipidus with partially preserved renal concentration function, which is caused by homozygous D150E mutation in the aquaporin-2 (AQP-2) gene
Tyulpakov A.N., Rubtsov P.M., Shandin A.N.

Nephrogenic diabetes Insipidus (NDI) is a heterogeneous disease in the etiopathogenesis of which acquired and congenital factors may be of importance. The authors describe a case of the familial type of NDI caused by aquaporin-2 deficiency. A 9-year-old boy and a 2-year-old girl, bom to closely related parents, were observed to have polydipsia and polyuria in the first months of life. A water deprivation test carried out in both children indicated the capacity of partially concentrate urine (urinary osmolality being increased from 160 to 614 m Osmol/kg in the boy and from 247 to 487 m Osmol/kg in the girl). At the same time, plasma osmolality changed from 229 to 252 m Osmol/kg in the boy and from 270 to 283 mOsmol/kg In the girl. Urinary osmolality remained unchanged after oral administration of minirin, 10: The dDAVP test using intranasalminirin, 20showed the elevated plasma concentrations of clotting factors (factor VIII and von Willebrand factor). Molecular genetic analysis of the AQP2 gene in both children revealed homozygous missense mutation in exon 2, leading to the substitution of aspartic acid for glutamic acid in position 150 (D150E). Their mother without clinical signs of NDI was found to be this mutation heterozygous. Therefore, D150E mutation in the AQP2 gene was detected in 2 siblings with NDI and partially preserved renal concentration function.

Problems of Endocrinology. 2007;53(5):13-18
Association of goiter endemic and latent iron deficiency in Western Siberia
Turovinina E.F., Suplotova L.A., Yuzhakova N.Y., Suplotov S.N., Sharukho G.V.

The purpose of the investigation was to study the prevalence of latent iron deficiency and goiter endemic and their association in prepubertal children in Western Siberia. A total of 2238 prepubertal children (8-12 years) living in 3 subjects of the Tyumen Region were examined in 2005-2006. The classical criteria for Iodine deficiency (ID), such as iodurla, the frequency of goiter at palpation and ultrasonography, were studied. Serum ferritln was determined by enzyme-linked immunosorbent assay using the DRG-Diagnostics ПРОБЛЕМЫ ЭНДОКРИНОЛОГИИ. 2007. Т. 53, № 5. kits (USA). There was normalization of the median ioduria, which was 117,', in the implementation of the ID prevention program in Western Siberia. By taking into account the 2003 WHO standards, the severity of goiter endemic in 2006 is regarded as moderate in the southern districts of the region and as severe in its autonomous areas. In terms of a serum ferritin level of less than 15 a high frequency of latent iron deficiency was found in the everywhere. Hence it follows that the association of the serum ferritin levels with the thyroid volumes is caused by a concomitance of two significant conditions: severe goiter endemic and frequent latent iron deficiency.

Problems of Endocrinology. 2007;53(5):18-21
Efficiency of radioiodine therapy for thyroid cancer metastasizing to the mediastinum and lung
Drozdovsky B.Y., Podolkhova N.V.

Thyroid cancer (ТС) accounts for 0.4-2% of all malignancies. The lung is a more frequent site of distant metastases. The use of 131I is prominent in the treatment of distant TC metastases. The Department of Radiosurgical Treatment with Open Radionuclides, Medical Radiology Research Center, Russian Academy of Medical Sciences, made a retrospective analysis of the results of radioiodine therapy (RIT) in 126 adult patients with TC metastasizing to the lung and mediastinum. The treatment was performed after thyroidectomy when levothyroxine was discontinued. Repeated courses of RIT with an activity of 1-1.5 mCu of 131I per kg body weight were performed at an interval of 3-6 months. Analysis of the findings showed the high efficiency of RIT in patients with differentiated TC metastasizing to the lung and mediastinum. Five- and ten-year survival rates were 95.1 and 79.3%, respectively. A complete effect could be achieved in 66 (71.7%) patients. The high efficiency of RIT was observed in patients with TC with metastases to the mediastinum, with X-ray-negative and small-focal metastases to the lung, with the high accumulation of radiopharmaceuticals in the metastatic foci and in those with a thyroid-stimulating hormone level of more than 30mU/L.

Problems of Endocrinology. 2007;53(5):22-24
Effectiveness and safety of radioiodine therapy for Graves' disease
Shestakova G.V., Strongin L.G., Budkina M.L., Sidorova N.A., Podupeiko N.Z., Shestakova A.V.

In 2005, in the MD PU City Hospital No. 13 of Nizhny Novgorod, a radiological department was created on the basis of a radioisotope laboratory for treating patients with Graves' disease with a radioiodine, which treats patients in the Nizhny Novgorod region and other regions of Russia.

OBJECTIVE: to determine the effectiveness of radioiodine therapy in Graves disease and the dependence of the outcome on the applied 131I activities and thyrostatic therapy.

Problems of Endocrinology. 2007;53(5):24-27
Evaluation of methylprednisolone pulse therapy versus combined therapy with prednisolone and cyclosporine in the treatment of infiltrative ophthalmopathy in Graves' disease
Dalmatova А.В., Grineva E.N.

The study was undertaken to evaluate the efficiency of methylprednisolone pulse therapy versus combined therapy with prednisolone and cyclosporine in the treatment of Graves' infiltrative ophthalmopathy. Twenty-four euthyroid patients (15 females and 9 males) aged 28 to 71 years who had severe active ophthalmopathy were randomized into 2 groups. Group 1 patients received pulse therapy with methylprednisolone while Group 2 patients were treated with a combination of prednisolone and cyclosporine. The efficiency of therapy was evaluated by the changes in indices by the clinical activity score (CAS), soft tissue inflammation (STI), average exophthalmos, the dysfunction of extraocular muscles, the total diameter of extraocular muscles by the data of computed tomography 2 weeks before the initiation of therapy and 36 weeks after its discontinuation. Following 2-week therapy, the patients from both groups had lower CAS, diminished inflammatory soft tissue manifestations by the STI scale, and alleviated average exophthalmos. Thirty-six weeks after therapy discontinuation, the values returned to the baseline ones in Group 1 patients whereas the achieved positive effect is retained in Group 2 patients.

Problems of Endocrinology. 2007;53(5):27-30
Trend in the quality of presenting the results of statistical analysis in the original papers in this journal in 1999 to 2006
Rebrova O.Y.

Fifty-eight original articles published in the journal "Problemy endokrlnologii" over 2005-2006 are analyzed in the context of the quality of presentation of the results of statistical analysis in them. The used methods were ascertained to be in compliance with the set tasks and the available data only in 17% of the articles, 15% of them contain no errors in the presentation of the results of statistical analysis, statistical analysis is described in necessary details in 13%. There is a positive trend as compared with that in 1999-2000.

Problems of Endocrinology. 2007;53(5):31-33
Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. (A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes)
Nathan D.M., Buse J.В., Davidson M.В., Heine R.J., Holman R.R., Sherwin R., Zinman B.

This Russian translation and reprint of the original article published with authors permissions. Original article published in the Diabetes Care. 2006;29(8). Translation to Russian prepared by Yu. Sych. An abridged version of the article was prepared by A. Gorbovskaya.

These recommendations and the algorithm are based on data from clinical studies of various treatment options for type 2 diabetes and on the personal experience of consensus participants, taking into account the main goal of treatment - to achieve and maintain glucose levels as close as possible to glycemia in healthy people. The lack of evidence of high levels of glycemia obtained in comparative clinical trials with a direct comparison of different treatment options for diabetes remains the main obstacle to isolating one main class of drugs or combination of drugs that have advantages over others.

Problems of Endocrinology. 2007;53(5):33-40
The problem of iodine deficiency in the Russian Federation and ways of its solution in a number of countries of the world
Fedak I.R., Troshina E.A.

International practice of the last two decades has demonstrated that universal salt iodization is the most effective, reliable and cost-effective method of preventing iodine deficiency in nutrition.

Problems of Endocrinology. 2007;53(5):40-48
Strontium ranelate (Bivalos): its place in therapy for post-menopasal osteoporosis (analysis of clinical trials)
Zotkin E.G., Eger I., Blumhardt S., Jubelhart В., Jubelhart D.

Postmenopausal osteoporosis is a progressive systemic disease of the skeleton, characterized by a decrease in bone mass and a violation of the architectonics of bones, accompanied by an increased tendency to fractures. Osteoporosis is an important medical and social problem due to its high prevalence and frequent complications - skeleton bone fractures, which lead to temporary and permanent disability, worsen the quality of life, and increase mortality, especially among the elderly. According to various authors, mortality rates during the 1st year after a femoral neck fracture range from 12 to 40%. In half of the patients who survived after the fracture, the ability to self-care is significantly limited or lost.

Problems of Endocrinology. 2007;53(5):49-53

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