Vol 55, No 4 (2009)

Clinical endocrinology
Pharmacoepidemiological analysis of outpatient therapy for type 2 diabetes
Verbovoy A.F., Barabanova N.A.

The paper presents the results of studying the actual treatment of patients with type 2 diabetes (T2D) receiving oral glucose-reducing agents. The case reports of 291 patients with T2D were analyzed. Poor adherence to the international and Russian guidelines for the management of T2D, unsatisfactory control of cardiovascular risk factors, and untimely correction of glucose-reducing therapy were revealed.

Problems of Endocrinology. 2009;55(4):3-6
Vaccination against pneumococcal and influenza infections in children and adolescents with type 1 diabetes
Skochilova T.V., Vorob'eva V.A., Kostinov M.P., Tarasova A.A., Korovkina T.I., Yushkova I.Y., Lukachev I.V.

The effect of a Pneumo 23 vaccine against pneumococcal infection (n = 72; Subgroup 1) in combination with a Grippol vaccine against influenza infection (n = 28; Subgroup 2) was studied in children and adolescents with type 1 diabetes on insulin therapy. A control group consisted of 30 unvaccinated children. Unlike monovaccination, combined vaccination was ascertained to cause a significant reduction in the glycated hemoglobin following a year. The daily dose of insulin and the levels of high-density lipoprotein cholesterol, triglycerides, and b-lipoproteins were unchanged in all the groups. The level of albumins increased, by approximating to the normal values. The blood content of urea and creatinine remained to be in the normal range at all stages of the study. In Subgroup 2 children microalbuminuria was significantly decreased. Within a year after vaccination, all the children and adolescents with T1D also showed a reduction in the number of disease decompensation episodes, which being significant in Subgroup 2, resulting from the reductions in the incidence and severity of acute respiratory infections. In the vaccinated children, the number of late vascular diabetic complications remained unchanged. Vaccination against pneumococcal infection in 13 children before hospital discharge in the subcompensation phase was followed by the same changes in the biochemical parameters and the clinical course of T1D parameters as in the patients vaccinated in the phase of compensation of the disease. The dynamic abdominal ultrasonographic pattern was found to become worse in the unvaccinated patients than that in Subgroup 1 patients. Analysis of clinical, laboratory, and instrumental results indicated the stability of the course of T1D in the children and adolescents vaccinated against pneumococcal and influenza infections.

Problems of Endocrinology. 2009;55(4):6-11
Left ventricular remodeling in patients in patients with thyrotoxicosis
Aripov M.A., Sviridenko N.Y., Tugeeva E.F., Buziashvili Y.I.

The aim of this paper was to investigate cardiac remodelling in thyrotoxicosis. The geometric parameters of the left ventricle (LV) and the readings of tissue Doppler echocardiography were compared in 27 patients (mean age 53.3±9.2 years) who had first-diagnosed moderate thyrotoxicosis without concomitant cardiac pathology and in 16 healthy individuals (mean age 45.1±4.7 years). The baseline data and the results of incremental treadmill exercise tests were analyzed. It was shown that in the relatively early periods of thyrotoxicosis development, there were decreases in the left ventricle (LV) longitudinally and transversely and in the thickness of LV, without altering its sphericity and conicity. Along with weight loss, there were reductions in cardiac sizes with decreases in the local rates of cardiac wall movement, peak systolic and early diastolic rates of mitral movement velocities. During a treadmill test, there was a drastic reduction in the exercise tolerance threshold as compared to healthy individuals: 57.81±14.7 and 148.3±11.7 W, respectively.

Problems of Endocrinology. 2009;55(4):11-15
The levels of thyroid hormones in hemorrhagic stroke
Elfimov A.V., Spirin N.N., Nozdrachev A.D., Fateev M.M., Ivanov A.O.

Radioimmunoassay using was used to study the blood concentrations of thyroid hormones (thyroid-stimulating hormone (TSH), T3, and T4) in patients with hemorrhagic stroke as intracerebral hematoma. The authors analyzed two patient groups: 1) those operated on for intracerebral hematoma removal; 2) those receiving medical treatment. Surgical intervention resulted in local fibrinolysis of a hematoma remnant. The level of thyroid hormones was studied over time from the 1st day to the 28th day of therapy. Each group was then divided into 2 subgroups: survivors and dead patients. Mortality group was 77.2% in the medical treatment group and 17.2% in the surgical treatment group. The performed studies established elevated concentrations in cases of good outcome of stroke. All the patients were found to have low T3 concentrations that were more pronounced in patients with a poor outcome. The level of T4 did not differ from the control values in patients with good results. Hematoma removal contributed to an increase in the concentrations of TSH and triiodothyronine

Problems of Endocrinology. 2009;55(4):15-20
Experimental endocrinology
The antidepressant effects of α-lipoic acid and reamberin in murine alloxan diabetes
Volchegorskiy I.A., Rassokhina L.M., Miroshnichenko I.Y.

The development of alloxan diabetes in mice is followed by a longer duration of despair behavior, homologous depression in man and a concomitant decrease in the activity of animals in the open field. The 2-week course of α-lipoic acid (α-LA) and reamberin in the doses equivalent to the human therapeutic range exerts an antidepressant activity, as appeared by a reduction in despair behavior and activation of sick mice in the open field. The antidepressant effect of 2-week use of α-LA and reamberin is associated with diminished hyperglycemia. Unlike α-LA, reamberin lowers the blood content of glucose in mice with alloxan diabetes, reduces their mortality, and corrects behavioral disorders in the open field even when relatively low doses are singly administered.

Problems of Endocrinology. 2009;55(4):20-24
Immunotherapy for type 1 diabetes: state-of-the-art and prospects. Part 1
Laptev D.N.

The review summarizes experimental data from immunological studies in diabetes. It presents the basic immunotherapeutic areas in diabetes and describes the proposed mechanism for developing immunological tolerance. On-going clinical studies are briefly overviewed.

Problems of Endocrinology. 2009;55(4):24-34
Estrogen receptors in the diagnosis and treatment of hormone-dependent tumors
Babichev V.N., Marova E.I., Fedotcheva T.A., Shimanovskiy N.L.

The paper presents the current data available on the etiology of tumor diseases, among other things, shows the role of hormones, namely: estrogens and their receptors, in the mechanism responsible for the occurrence of these diseases. Each tumor was shown to have its receptor status and to be unresponsive to this or that therapy differently. The efficiency of treatment and its prognosis may be determined if the receptor composition of an involved organ is estimated correctly. The authors summarize the data available in the literature, as well as the results of their own investigations explaining the selective effect of estradiol receptor agonists and antagonists in various tissues. The mRNA varieties that potentially encoding for the synthesis of different subtypes of estrogen receptors (ER) - ER-α and ERβ, which are also coded by various genes located in different chromosomes. Pituitary adenomas as hormone-dependent masses are described in detail. The authors data on the concentration of nuclear estrogen receptors in different types of adenomas are given.

Problems of Endocrinology. 2009;55(4):34-36
Classification, diagnosis, and treatment of idiopathic short stature
Shandin A.N., Peterkova V.A.

Idiopathic short stature is the low stature in which all possible causes are excluded. The diagnosis and treatment of idiopathic short stature are the subject of constant controversy and discussion. With the expansion of indications for growth hormone therapy for conditions unaccompanied by growth hormone deficiency, there has been recently a challenge as to its use in idiopathic short stature. To date, there has been much worldwide evidence for the efficiency and safety of growth hormone therapy in children with idiopathic short stature. In 2008, the International consensus on the diagnosis and management of idiopathic short stature, prepared through the joint collaboration of three research societies: the Growth Hormone Society, the Lowson Wilkins Society of Pediatric Endocrinology (USA), and the European Society of Pediatric Endocrinology. The main points of this document have formed the basis for this paper.

Problems of Endocrinology. 2009;55(4):36-44
Adipose tissue inflammation. Part 1. Morphological and functional manifestations
Shvarts V.

The review describes a new pathomorphological phenomenon: adipose tissue inflammation (ATI) that develops in obesity and is characterized by cell infiltration, fibrosis, microcirculatory changes, a shift in adipokine secretion and adipose tissue metabolism, as well as blood accumulation of nonspecific inflammatory markers, such as C-reactive protein, fibrinogen, leukocytes, the level of which reflects the degree of the process. The changes in adipokine secretion and shifts in fat and carbohydrate metabolism, which are typical of ATI, favor the development of atherosclerosis, essential hypertension, type 2 diabetes, and the metabolic syndrome. ATI shows up as a connecting link between these diseases and obesity. The definition of obesity as a chronic inflammatory disease is justified.

Problems of Endocrinology. 2009;55(4):44-49
Capacities of complex ultrasonography in the differential diagnosis and management of thyroid nodular masses
Ul'yanova A.E., Yarchenkova L.L.

The review presents the capacities of Doppler ultrasound study in the differential diagnosis and management of thyroid nodular masses. The problem of goiter does not presently lose its urgency. Palpable thyroid nodular masses are detectable in 4-7% of the worlds population [3, 4, 25] and the detection rate of thyroid abnormalities via radiation studies is 20 to 50% [4, 5]. Complex ultrasonography (USG) increases the obtained volume of information and its clinical value in nodular goiter. Examination of blood circulation in the thyroid and nodular masses involves two-dimensional gray-scale echography, color Doppler coding and Doppler spectrum analysis. The present Doppler study with color Doppler coding makes it possible to unify an assessment of the distribution of color flow maps in the vessels of nodular masses. Doppler spectrum analysis in nodular masses can confirm the enhanced blood flow in nodular tissue as compared with that in the intact parenchyma (increased linear blood flow velocities in the intranodular and/or perinodular arteries as compared with those in the adjacent tissue arteries). Doppler USG introduced early after thyroid surgery provides objective information on the area operated on and evaluates the course of its wound process, diagnoses early postoperative complications, and defines the adequacy of performed surgical intervention [1, 3, 7].

Problems of Endocrinology. 2009;55(4):49-54
Short Messages
Idiopathic short stature: nosological entity, terminology, capabilities of therapy
Kasatkina E.P.

The paper deals with idiopathic short stature, one of the problems of pediatric endocrinology, and discusses the pattern and causes of this condition. Recommendation are given on the examination and treatment of children with the most common forms of short stature, such as late puberty, family short stature.

Problems of Endocrinology. 2009;55(4):54-56

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