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Vol 43, No 3 (1997)

Iodine deficiency diseases in children and adolescents (plenary lecture)
Kasatkina E.P.
Abstract

The main consequence of iodine deficiency in the environment is the development of goiter in people living in iodine-deficient regions (endemic goiter). In this regard, for a long time it was considered that goiter is the only manifestation of this condition. It has now been proven that, in addition to goiter, iodine deficiency also has other adverse effects on human health. In 1983, the term "endemic goiter" was replaced by the term  "iodine deficiency diseases" (IDD). These diseases are caused by a decrease in the functional activity of the thyroid gland in response to iodine deficiency.

Problems of Endocrinology. 1997;43(3):3-7
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Biological properties of hepoxylines
Fedotov V.P., Sadovnikova N.V., Gudoshnikov V.I., Baranova I.N., Vasilyeva L.L., Pivnitsky К.K.
Abstract

Hepoxylines, arachidonic acid metabolites, are present in many tissues of the body and regulate various cell functions. We investigated the biological effects of hepoxylines B3 (10R and 10S epimers) on the secretory processes using primary cultures of rat pancreatic islet cells, adenohypophyseal ceils, and hepatocytes. Hepoxylines added to culture medium boosted the secretion of insulin and serum albumin and inhibited prolactin secretion. Hepoxyline effect on insulin secretion did not depend on the presence of glucose in the medium. Experiments on a model of type 11 diabetes showed that exogenous hepoxylines partially repair the islet cell sensitivity to glucose. Impaired synthesis of hepoxylines and their metabolism or receptor interactions with pancreatic p-cells may be one pathogenetic factor in the development of non-insulindependent diabetes mellitus. In order to verify this hypothesis, methods and agents boosting and inhibiting the production of endogenous hepoxylines are needed and the effects of hepoxylines on tissues resistant to insulin because of type II diabetes are to be studied.

Problems of Endocrinology. 1997;43(3):8-12
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Autoimmune process markers in insulin-dependent diabetes mellitus
Galenok F.A., Zhuk Y.A.
Abstract

Quantitative and functional parameters of the monocyte and В-cell immunity were assessed in patients with insulin-dependent diabetes over the course of disease. Studies of the monocyte component in subjects predisposed to disease and of the humoral one in those with clinical manifestations are valuable for predicting the autoimmune process. Signs predicting a poor outcome are increase of the count of Fc-positive cells, decrease of NBT reduction of monocytes in subjects without signs of the disease, high levels of immunoglobulin G in manifest disease, and increase of IgM and B-lymphopcyte count and decrease of IgA over the course of the disease.

Problems of Endocrinology. 1997;43(3):13-16
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Diabetic involvement of the organ of vision
Nesterov A.P.
Abstract

Diabetic involvements of the organ of vision may be divided into extraocular and ocular. The first group includes xanthelasma and eczemas of the eyelids, hordeolum, chalasion, blepharitis, acute and chronic conjunctivitis, conjunctival angiopathies, and pareses of the extraocular muscles. The second group in- cludes*iridal dystrophy, anterior uveitis, cataract, glaucoma, asteroid hyalosis, lipemia rctinalis, and diabetic retinopathy with its complications (hemophthalmia, detachment of the retina, and neovascu- lar glaucoma). Diabetic retinopathy is a late complication of diabetes mellitus. The author discusses the epidemiology of this condition, its pathophysiological and clinical features, classification, contribution of local factors to its pathogenesis, and possibilities of treatment and prevention of the disease. He emphasizes the leading role of optimal correction of carbohydrate metabolism as a means preventing diabetic retinopathy and of timely laser photocoagulation of the retina in its treatment.

Problems of Endocrinology. 1997;43(3):16-19
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Prospects in the treatment of diabetic nephropathy
Shestakova M.V., Vorontsov A.V., Vykhristyuk S.G., Dedov I.I.
Abstract

The authors discuss new approaches to the treatment and prevention of diabetic nephropathy based on elimination of the pathogenetic factors of its development. Hyperglycemia, the main triggering factor of vascular complications of diabetes mellitus. induces a cascade of other pathological reactions, such as renal dysfunction, biochemical and structural changes in the basal membranes of renal capillaries, and stimulates the secretion of vasoactive factors of vascular endothelium and platelets. Blocking of these reactions by specific agents inhibits the progress of diabetic nephropathy. The authors share their experience gained in the treatment of diabetic nephropathy with inhibitors of angiotensin-converting enzyme, glycosaminoglycanes, and thromboxane synthesis inhibitors. These drugs are more effective if prescribed at the early stages of diabetic involvement of the kidneys.

Problems of Endocrinology. 1997;43(3):20-22
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T-activin in combined therapy of type I diabetes mellitus
Novikov V.I., Shostak V.A.
Abstract

The effects of t-activin on the time course of immunohormonal, metabolic, and clinical parameters were studied in patients with newly diagnosed type I diabetes (n = 50, aged 17 to 35, followed up for 2 years; controls: 20 patients with type 1 disease treated traditionally). An appreciable decrease of basal and stimulated levels of C-peptide, shifted T-helper to T-supprcssor ratio caused by a decrease of T-suppressor level, and an increase of the immunoregulatory index were observed at the debut of type 1 diabetes; these shifts gave grounds sufficient to prescribe t-activin. Tactivin therapy for 2 years led to a decrease of the T-helper/T-suppressor imbalance due to an increase of the T-suppressor content, normalization of IRI, increase of the basal and stimulated C-peptidc levels, normalization of HbAlc at a daily insulin dose of 0.4 U/kg, and a stable course of the disease. In the controls the immune parameters and hormones did not normalize, daily insulin dose was 0.6 U/kg, and the disease course unstable. Hence, t-activin not only corrected the immunity, but metabolism as well, which resulted in stimulation of repair regeneration of pancreatic p-cells.

Problems of Endocrinology. 1997;43(3):23-25
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Antithyroid antibodies and autoimmune diseases of the thyroid
Kandror V.I., Kryukova I.V., Krainova S.I., Mkrtumova N.A., Keda Y.M., Sviridenko N.Y., Bazarova E.N., Latkina N.V.
Abstract

The significance and mechanisms of action of different antithyroid antibodies in diffuse toxic goiter (Graves' disease) and chronic lymphocytic thyroiditis (Hashimoto’s disease) arc analyzed. Antibodies immediately decreasing the level of cAMP in isolated thyrocytes were revealed in the sera of adolescents with juvenile struma, often resulting from lymphocytic thyroiditis. Complement-fixing cytotoxic antibodies are heterogeneous in patients with Graves' diseases and Hashimoto's thyroiditis. Thyrocytes from the tissue of diffuse toxic goiter are resistant to the cytolytic effect of such antibodies from patients with Graves' diseases but not from patients with Hashimoto's thyroiditis. The causes and mechanisms of development of resistance of thyrocytes from diffuse toxic goiter to antibody-dependent complement-mediated cytotoxicity of sera from patients with Graves' disease and the possibility of using this phenomenon as a differential diagnostic test are discussed.

Problems of Endocrinology. 1997;43(3):25-30
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Cytological diagnosis of thyroid disease
Bronstein M.E.
Abstract

Cytological diagnosis of various human diseases is widely used in modern medicine, especially for early preoperative diagnosis of tumors of different organs and tissues. A fine-needle aspiration puncture biopsy followed by microscopic examination of its cytogram is one of the integral parts of diagnostic cytology, including the diagnosis of thyroid diseases (thyroid gland). The methods used to verify various thyroid pathology options (palpation, ultrasound - ultrasound, scintigraphy, biochemical and immunological tests, etc.) do not always allow us to clarify the nature of pathological changes in the thyroid gland. For example, cold nodes (according to the scan) only in some cases turn out to be malignant neoplasms of the thyroid gland, like the bulk of nodular goiter in patients from regions endemic to goiter; in most cases there is no need for their prompt removal. And only a microscopic examination of thyroid puncture points, especially its nodular formations, allows you to clarify the diagnosis and make an adequate decision on the nature of the treatment measures. Thin-needle aspiration puncture biopsy of the thyroid gland is a non-invasive morphological diagnostic tool that allows you to make a correct diagnosis with almost 100% probability. At the same time, since the thyroid gland is an epithelial organ, in the structures of which the cells are closely “fused” with each other, cellular connections are broken with difficulty, which makes it extremely difficult to obtain informative material for subsequent microscopic examination. To facilitate the process of obtaining material on the needle, which is performed by puncture biopsy, in the Endocrinology Research Center of the Russian Academy of Medical Sciences, notches were started at a distance of about 0.5-0.7 cm from the sharp end of the needle (Candidate of Medical Sciences A.V. Antonov), which allows you to take material like a harpoon, without aspiration and receive a plentiful punctate. With ischemia of the punctured area of the gland, it is possible to obtain abundant punctate with virtually no impurity of peripheral blood (Ph.D. I.V. Panteleev). The material thus obtained is applied to a fat-free glass slide and a smear is obtained using a polished glass slide (similar to a blood smear). Air-dried strokes are stained according to May — Grunwald — Giemsa. Every year we examine from 1.5 to 2.5 thousand puncture biopsies from patients with various pathologies. The information content of the obtained material largely depends on the experience and skill of the surgeon. Scanty punctate, as a rule, is uninformative and can only describe the punctate without an opinion on the nature of pathological changes in the thyroid gland. Abundant cellular punctate from different points of the gland, especially if there is a suspicion of diffuse and / or combined pathology, makes it possible to make a final diagnosis.

Problems of Endocrinology. 1997;43(3):30-38
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Differential diagnosis of thyroid diseases by the x-ray fluorescent method
Tomashevsky I.О.
Abstract

Intrathyroid stable iodine (ISI) was measured in 249 women aged 36 to 55 living in Moscow. 179 of these suffered from thyroid tumors and autoimmune thyroiditis and 70 without history of thyroid diseases with normal thyroid status confirmed by clinical laboratory data and ISI values of at least 200 pg/g, considered as the critical, were controls. ISI concentrations were measured using a Russian commercial sample for noninvasive x-ray fluorescent analysis. Using the same device, ISI was measured in thyroid samples with cancer and benign tumors, embedded in paraffin blocks, sent from the USA (n - 47) and Russia (n = 126); in addition, these samples were examined histologically. ISI concentrations were lower in cancer, thyroid adenomas, and autoimmune thyroiditis than in control. An ISI concentration lower than 200 pg/g indicates autoimmune thyroiditis with a probability of 96%. Use of L- thyroxin test increases the probability of the disease recognition to 98%.

Problems of Endocrinology. 1997;43(3):38-42
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Neuroendocrine control of the pituitary gonadotropic function in experimental diabetes
Babichev V.N., Adamskaya E.I., Kuznetsova T.A., Shishkina I.V.
Abstract

The hypothalamo-pituitary-gonadal system was examined in male and female rats with experimental diabetes in­duced by streptozotocin (STZ). Injection of STZ caused a decrease of testosterone (T) concentration and of T nuclear receptors in the pituitary. The levels of luteinizing and follicle stimulating hor­mones (LH and FSH) in the blood of diabetic rats did not differ from those in intact animals. In vitro experiments showed that the development of diabetes did not change the basal secretion of LH by the pituitary in males. Maximal response to LH-RH was record­ed in control males after 3-hour incubation, whereas the rate of LH secretion in experimental rats did not differ from basal values. In­jection of STZ to cycling females disordered the estrous cycle and involved decreases of the basal and cyclic secretion of LH, FSH, and sex hormones. The concentrations of estradiol nuclear receptors in the preoptic anterohypothalamic region and pituitary decreased, whereas the number of T-binding sites decreased only in the pitui­tary. Sex hormone-stimulated gonadotropin wave in oophorect- omized females was decreased in diabetes, which was due to changed activity of the LH-RH producing system. The authors hy­pothesize that changes in the mechanism of regulation of the hy­pothalamo-pituitary-gonadal system in experimental diabetes are re­lated to pituitary disorders in males, whereas changed basal and cy­clic secretion of LH and FSH in females is caused by disordered activity of the LH-RH production and receptor binding at the level of the hypothalamo-pituitary complex.

Problems of Endocrinology. 1997;43(3):43-47
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Insulinreceptor interactions and EPR spectroscopy in experimental diabetes mellitus
Mikaelyan N.P., Knyazev Y.A., Maxina A.G., Dainyak B.A., Gurina A.Y., Mikaelyan E.P., Dzugkoyeva F.S.
Abstract

Insulin concentration in the blood and the level of its binding in tissues inversely correlate in experimental diabetes mellitus. Insulin-binding activity in cells and the microviscosity and hydrophilism of plasma membranes are in inverse correlation. ATP modifies insulin reception.

Problems of Endocrinology. 1997;43(3):48-50
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The macroprolactinemia phenomenon: origin and clinical diagnostic significance
Bulatov A.A.
Abstract

The authors discuss the experimental and clinical data on the origin, properties, and diagnostic value of serum immunoreactive prolactin (irPRL) with a high molecular mass (macroprolactin, 100K-PRL). This form predominates in the blood of about 25% of women of a reproductive age with hyperprolactinemia. Comparison of the biochemical, immunochemical, and functional characteristics of the blood serum 100K-PRL and the monomeric fraction irPRL (23K-PRL) showed them to differ in principle. A low biological activity of 100K-PRL explains the absence of typical clinical signs of hyperprolactinemia in many women with macroprolactinemia. In contrast to 23K-PRL, 100K.-PRL weakly reacts to stimulants and inhibitors of PRL secretion by the pituitary. PRL-binding protein, apparently an immunoglobulin, is the basis of fraction 100K-PRL. The authors consider that analysis of not only total irPRL in the blood, but of its high and low-molecular forms be included in the algorithm of diagnostic search in some forms of hyperprolactinemia. This will help determine the treatment policy, because moderate hyperprolactinemia with predominating 100K- PRL as a rule cannot be corrected by dopamine agonists.

Problems of Endocrinology. 1997;43(3):50-55
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