Vol 56, No 1 (2010)

Screening for diabetic complications as a tool for the evaluation of medical and preventive aid to patients
Suntsov I.I., Maslova O.V., Dedov I.I.
The objective of this work was to study the actual prevalence of diabetes mellitus complications and evaluate the quality of health care provided to the patients with these problems in different regions of Russia. A random sample of 11 240 patients with diabetes mellitus (DM) was obtained from a total of 20 regions of the Russian Federation. The study protocol included evaluation of visual function, the state of peripheral nervous system and lower extremities, renal and cardiovascular functions; in addition, HbA1c, creatinine, total cholesterol and triglyceride levels were measured along with albuminuria. It was found that the actual prevalence of major diabetic complications is 20-50% higher than the registered one. The overwhelming majority of the patients were shown to be chronically decompensated. This finding holds for 85.5% of the children, 92.6% of the adolescents, 83.9% and 74.8% of the adult patients with types 1 and 2 DM respectively. The HbA1c level in patients living in rural areas was 33.7-42.1% higher than in residents of regional urban centres. Fewer than 14.4% and 0.6% of the patients with type 2 DM used insulin and its analogs respectively. Overall, the study demonstrated rather poor quality of medical and preventive aid provided to diabetic patients and the necessity of its improvement.
Problems of Endocrinology. 2010;56(1):3-8
Biochemical risk factors of vascular complications in children with type 2 diabetes mellitus in the late postoperative period following reconstructive surgery
Pokrovskiĭ A.V., Doguzhieva R.M., Demidova V.S., Lebedeva A.N.
The objective of the present study was to compare levels of homocysteine (HC), total cholesterol (TC), triglycerides, high and low density lipoproteins (HDLP and LDLP respectively), and C-reactive protein (CRP) and to evaluate their role in the development of atherosclerosis in patients with type 2 diabetes mellitus (DM2) or without it in the late postoperative period following aortofemoral reconstructive (AFR) operations. A total of 79 patients (40 with DM2 and 39 without it) examined after AFR surgery had the above parameters enhanced compared with the respective baseline values. In the majority of the cases, hyperhomocysteinemia (HHC) was associated with the increased levels of CRP, fibrinogen, and LDLP. However, they were higher in patients with DM2 than without it and correlated with the HbA1c level (r=0.32-0.45; p<0.05). In DM2 patients with HHC, simultaneous hyperlipidemia and elevated CRP levels, the thickness of the intima-media complex in aorta, popliteal artery, anterior and posterior tibial arteries significantly increased. Moreover, these patients experienced more apparent stenosis of these arteries (>50%). Patients with DM2 more frequently exhibited a combination of several markers of the atherosclerotic process especially in the presence of the smouldering inflammatory process in the vascular wall.
Problems of Endocrinology. 2010;56(1):9-13
Expression of somatostatin and dopamine receptors in ACTH-producing tumours
Dedov I.I., Marova E.I., Abrosimov A.I., Lapshina A.M., Grigor'ev A.I.,  Ablitsov I.A., Kuznetsov N.S., Goncharov N.P., Arapova S.D., Rozhinskaia L.I.
This study was designed to compare immunoexpression of somatostatin receptors (SR)1-5 and dopamine receptors 2 (DR2) in pituitary and non-pituitary ectopic ACTH-producing tumours. A total of 35 patients were enrolled in the study including 21 with Cushing's disease (CD) and 14 with ACTH-ectopic syndrome (ACTH-ES) associated with carcinoid tumours of lungs (n=11), kidney (n=1), thymus (n=1) and with small-cell lung carcinoma (n=1). All patients with corticotropinomas exhibited expression of SR 1-5 dominated by SR-1 (57%). 81% of these tumours expressed two and more SR subtypes. DR2 expression was documented in 52% of the tumours and co-expression of DR2 with different SR subtypes in 29%. Neoplasms associated with ACTH-ES expressed SR with the predominance of SR-3 (72%). Half of these tumours co-expressed two and more SR subtypes. Expression of DR2 was demonstrated in 50% of the neoplasms associated with ACTH-ES; 38% of them co-expressed SR and DF2.
Problems of Endocrinology. 2010;56(1):14-18
Clinical and laboratory aspects of investigations into prolactin isoforms by PEG precipitation and ultrafiltration techniques
Mel'nichenko G.A., Goncharov N.P., Dzeranova L.K., Dobracheva A.D., Barmina I.I.
The objective of this work was to study prolactin (PRL) isoforms using two methods, polyethylene glycol (PEG) precipitation and ultrafiltration (UF). Sera from 41 patients with hyperprolactinemia were available for analysis. The two techniques revealed roughly similar levels of monomeric and high-molecular weight PRL variants. The somewhat lower monomeric PRL level following UF may be attributed to separation of not only macroprolactin but also of dimeric forms of the hormone during filtration. The clinical picture of the disease and brain MRI images of the patients were consistent with low-molecular weight PRL levels. Comparison of monomeric PRL levels showed no significant difference between the results of measurements by the two methods.
Problems of Endocrinology. 2010;56(1):19-25
Effect of female sex hormones on microbicidal activity of neutrophils
Shirshev S.V., Nekrasova I.V.
The objective of the present work was to study effects of estradiol and progesterone on enzymatic, oxidative, and phagocytic function of human neutrophils. It was shown that sex hormones applied at the doses equivalent to their concentrations in pregnant women selectively stimulated spontaneous activity of neutrophilic elastase and increased myeloperoxidase enzymatic activity. Neither estradiol nor progesterone had apparent effect on baseline spontaneous hemiluminescence of neutrophils but stimulated E.coli-induced luminol-dependent hemiluminescence. Simultaneously, both steroids inhibited phagocytic activity of these cells. It is concluded that this modulating action of female sex steroids on neutrophil functions is likely to come out during pregnancy.
Problems of Endocrinology. 2010;56(1):26-30
Treatment of oligospermia in male infertility
Rozhivanov R.V., Parfenova N.S., Kurbatov D.G.
We examined 22 infertile patients with oligospermia to evaluate efficiency of hormonal therapy. All the patients were treated with clomiphene citrate or chorionic gonadotropin for 3 months and showed significant elevation of testosterone levels. Clomiphene therapy caused a statistically significant rise in the number of spermatozoa per 1 ml ejaculate and percentage of their morphologically intact forms coupled to insignificant improvement of sperm motility (A + B). Sexual partners of two patients reported being pregnant. Treatment with chorionic gonadotropin resulted in a significant rise in the number of spermatozoa per 1 ml ejaculate and insignificant increase in percentage of their morphologically normal forms. No improvement of (A + B) spermatozoon motility was documented. The partner of one patient developed pregnancy. Patients of either group with azoospermia failed to exhibit spermatozoa in the ejaculate after the treatment. It is concluded that the two therapeutic modalities are efficacious in terms of increasing the total number of spermatozoa. Their additional advantage is normalization of the total testosterone level. Moreover, therapy with clomiphene citrate brought about a rise in the number of morphologically adequate cells. However, neither modality produced beneficial effect in patients with azoospermia.
Problems of Endocrinology. 2010;56(1):31-34
Efficacy and safety of Bivalos therapy in patients with postmenopausal osteoporosis without calcium and vitamin D supplement
Marchenkova L.A., Dreval' A.V., Kriukova I.V., Vishniakova M.V., Poliakova E.I., Tishenina R.S., Rubin M.P.
Problems of Endocrinology. 2010;56(1):35-41
Treatment of patients with diabetes mellitus following kidney transplantation
Bondar' I.A., Klimontov V.V.
Problems of Endocrinology. 2010;56(1):42-47
Adrenal masses (diagnosis and differential diagnosis)
Molashenko N.V., Iukina M.I., Soldatova T.V., Rogal' E.A.
This review of the literature is focused on diagnosis and differential diagnosis of adrenal incidentalomas with special reference to diagnostic steps, major pharmacological tests, radiologic and instrumental studies. Strategies of treatment and management of patients with this pathology are described.
Problems of Endocrinology. 2010;56(1):48-56
Current concepts of disturbed sexual differentiation
Ustinkina T.I., Shustov S.B.
Problems of Endocrinology. 2010;56(1):57-62
Bel'tsevich D.G., Troshina E.A., Iukina M.I.
Problems of Endocrinology. 2010;56(1):63-71

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