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Vol 40, No 1 (1994)

Clinical endocrinology
Some data of diabetes mellitus register
Kudryakova S.V., Suntsov Y.I.
Abstract

Data on lethal cases of diabetes mellitus which occurred before January 1, 1992 were recorded. The total number of diabetics in Leninsky district of Moscow was 1729, 86 of them with insulin-dependent and 1643 with noninsulindependent disease. Diabetes prevalence in the district was 2.4 %, that of insulin-dependent condition being 0.12 % and of noninsulin-dependent one 2.3 %. Various complications were detected in the majority of diabetics, microangiopathies (retinopathies, neuropathies) being the most incident in patients with insulin-dependent disease and macroangiopathies (coronary disease, arterial hypertension, myocardial infarction, brain stroke) predominating in patients with noninsulin-dependent disease. Cardiovascular diseases and involvement of the peripheral vessels were the most frequent causes of death of patients with both conditions.

Problems of Endocrinology. 1994;40(1):4-6
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Constitutional and dermatoglyphic characteristics of children with diabetes mellitus
Bets L.V., Dzhanibekova I.V., Lebedev N.B., Kurayeva T.L.
Abstract

A group of Russian children with clinically diagnosed diabetes mellitus were examined using a comprehensive constitutional dermatoglyphic program. Pattern asymmetry was observed in children of both sexes. On the whole the examined population was characterized by reduced incidence of loop patterns and increased incidence of double-delta patterns. In boys the incidence of arches and coils was higher and that of loops lower than in controls, in girls there were no arches and the incidence of radical and ulnar loops was low. Analysis of genetically determined signs, both anthropometric and dermatoglyphic ones, and use of other criteria will help assess the significance of these signs as markers of risk of development of type I diabetes.

Problems of Endocrinology. 1994;40(1):6-9
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Non-insulin-dependent diabetes mellitus in young patients with autosomic dominant type of inheritance
Lebedev N.B., Scherbacheva L.N., Koledova E.B., Trofimenko E.V., Mayorov A.Y.
Abstract

In 1964, S. Fajans first used the term “Maturity onset diabetes in young people (MODY)” to define non-progressive or slightly progressive diabetes, found in some children, adolescents, young adults, and associated with a clear family history of diabetes . In 1974, R. Tattersall reported 3 families whose members suffered from this form of diabetes and proved an autosomal dominant type of inheritance. In 1975, S. Fajans and R. Tattersall made a differential diagnosis between inheritance of type I diabetes mellitus (DM) and "mature diabetes in young people", once again confirmed the autosomal dominant inheritance of the latter and for the first time used the abbreviation MODY. MODY is also referred to as “insulin-independent diabetes mellitus (NIDDM) in young people” (abbreviated NIDDY). Unfortunately, none of the abbreviations gives a complete definition of the syndrome. Perhaps the best definition belongs to S. Fajans: MODY is NIDDM in young people with autosomal dominant inheritance.

Problems of Endocrinology. 1994;40(1):9-14
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Energy expenditures of outpatients and inpatients with insulin-dependent diabetes: A computer analysis
Dreval A.V., Anykina N.V., Nefyodova G.A., Tishin D.P., Zubenko A.D., Proshina I.V.
Abstract

Original computer programs for assessment of energetic value of nutrition and daily energy expenditures of man based on physical activity protocols have been developed. The programs were tried in 16 patients with insulin-dependent diabetes, and essential individual differences from tentative table estimations of energy expenditures were detected. Correlations between treatment efficacy and individual energy expenditures of patients were observed; a moderate deficit of nutrition calories was found more detrimental for metabolic control than their moderate excess. The regularities detected even in such a nonrepresentative sample permit us evaluate high the potentialities and significance of the suggested method for assessment of energy expenditures.

Problems of Endocrinology. 1994;40(1):14-17
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Cellular immunity of patients with newly detected insulin-dependent diabetes
Dedov I.I., Chugunova L.A., Smirnova O.M., Brykova S.V., Schegolkova T.S.
Abstract

Twenty-five diabetics with insulin-dependent condition were examined at the debut of the disease before insulin therapy, as were 10 healthy donors. Under study were relative and absolute counts of T lymphocytes, NK cells, В lymphocytes, DR-T lymphocytes, Th, Ts, and Th/Ts index. Patients’ and donors’ sera were tested for autoantibodies to P64 —69kD antigenic complex. Characteristic features of cellular immunity of patients with newly-detected diabetes were disclosed. Counts of В lymphocytes and Dr-T lymphocytes were increased in all patients. A relationship was revealed between immunoregulatory Th/Ts index and clinical features of insulin-dependent diabetes. Autoantibodies to p64—68 kD andigenic complex were detected in 63-88 % of patients with newly detected insulin-dependent diabetes.

Problems of Endocrinology. 1994;40(1):17-20
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Atherogenic effect of sugar-reducing sulfonylurea drugs and its elimination by papaverin
Maxumova M.A., Sobenin I.A., Balabolkin M.I., Orekhov A.N.
Abstract

Effects of oral sugar-reducing sulfonylurea drugs, glybenclamide, glypizide, and glyclaside, on intracellular cholesterol level of murine peritoneal macrophages were studied, as were papaverin effects on atherogenicity induced by sulfonylurea derivatives. Direct effect of sulfonylurea preparations and of blood sera from patients with type II1 diabetes on atherogenic potential after the said drugs intake were studied in cell cultures. All the drugs mentioned increased intracellular cholesterol level by 1.5 times both' in vitro and in vivo. Papaverin, if administered simultaneously with sulfonylurea drugs, markedly reduced atherogenic potential induced by these drugs. Addition of papaverin to culture medium containing 10-4 mole/liter of sulfonylurea drugs resulted in a reliable reduction of their atherogenic effect, the maximal effect being observed at papaverin concentration 10~5 mole/liter. Hence, papaverin is capable of eliminating an unfavorable atherogenic effect of sylfonylurea drugs.

Problems of Endocrinology. 1994;40(1):20-22
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Dopaminergic regulation of the hypothalamohypophyseoadrenal system in Icenko-Cushing's disease
Sysoyeva I.I., Dedov I.I.
Abstract

Nineteen patients with Icenko-Cushing’s disease aged 13 to 18 were examined during an active stage of the disease and during a remission after proton exposure of the hypophysis. Nine normal subjects were controls. Adeno- hypophyseal tropic hormones and hydrocortisone were radioimmunoassayed before and after administration of nakom, a dopaminergic agent. ACTH, hydrocortisone, TTH, parlodel secretion were found decreased and LH increased in patients with Icenko-Cushing’s disease, and no STH increase characteristic of normal subjects was observed. During remission after proton therapy adenohvpophyseal tropic hormones and hydrocortisone secretion normalized in response to nakom. Recovery of STH secretion was observed, but not in all patients, this being confirmed by the absence of a normal somatotropin response in nakom test in 26.32 % of patients.

Problems of Endocrinology. 1994;40(1):22-26
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Histochemical characteristics of aldosteromas and adrenal tissue of patients with primary hyperaldosteronism
Bronstein M.E., Chikhladze N.M.
Abstract

The authors analyze the data of histochemical examinations of 30 patients with tumorous and nontu- morous forms of low-renin hyperaldosteronism, as well as the findings of clinical and hormonal examinations of these patients. The activities of enzymes involved in steroidogenesis (3-pOSD, NAD and NADP tetrazoleum reductases, G-6-PD) were measured, as were levels and distribution patterns of lipids involved in steroidogenesis (free and bound cholesterol, etc.). A high functional activity of aldosteromas of any structure was proved, and a trend to increase of steroidogenic activity of malignant aldosteromas demonstrated. Atrophic changes in the cortex adjacent to aldosteroma were found to involve no reduction of adrenal tissue functional activity. In contrast to this, hyperplastic changes in the cortex adjacent to adenoma were characterized by a lower level of functional activity as against adrenal tissue activity in nontumorous hyperaldosteronism. The authors come to a conclusion that adrenocortical elements hyperplasia associated with some aldosteromas does not participate in aldosterone hyperproduction whereas hyperaldosteronism in nontumorous variants is caused by cortical cell hyperplasia and hormone hyperproduction.

Problems of Endocrinology. 1994;40(1):26-30
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Case Reports
Combination of Sjogren’s disease with autoimmune thyroiditis: A case history
Sycheva Y.A., Khein T.S.
Abstract

Therapists, including rheumatologists, often forget that many autoimmune diseases are combined with endocrine pathology, in particular with thyroid pathology.

These cases, according to the classification of N. Smith and A. Steinberg, belong to the 5th class - class E of autoimmune diseases, which includes conditions that manifest several autoimmune diseases, both organ-specific and organ-specific.

In the literature, cases of combinations of endocrine diseases with non-endocrine autoimmune are described. It was noted that they are most often found in young women, which are associated with the X chromosome.

We give our own observation of a patient with Sjogren's disease in combination with thyroid pathology.

Problems of Endocrinology. 1994;40(1):30-31
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For practitioners
Corticotropinomas. Early diagnosis and therapy (Lecture)
Semin V.Y., Trunin Y.K.
Abstract

A systematic study of patients who died from various diseases shows the presence of pituitary tumors in 6.8-22.6% of cases. In fact, in many cases, neither doctors nor patients are even aware of their existence. This was first noticed by Costello in 1929. Using standard methods for staining autopsy material, he divided most tumors into 4 groups: chromophobic (52.8%), resembling eosinophilic (7.5%), basophilic (27.2% ), mixed (12.4%).

These were the first steps in the study of pituitary adenomas. With the advent of adequate histochemical techniques, chromophobic adenomas began to be regarded as secretory-active. However, the high incidence of autopsy adenomas contrasts sharply with the relatively low incidence of clinically apparent tumors.

Problems of Endocrinology. 1994;40(1):31-35
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Automonitoring Principles and Methods in Endocrine Diseases
Current methods and means of metabolism automonitoring in diabetes mellitus
Starostina Y.G., Galstyan G.R., Dedov I.I.
Abstract

Self-control (SC) in the broad sense of the word is the registration of trained patients with diabetes mellitus, subjective sensations, glycemia, glucosuria and other indicators, as well as diet and physical activity in order to make independent therapeutic decisions. It is more correct to use the term “self-control” in the narrow sense, only to indicate SC metabolism, that is, to independently determine the patient’s blood sugar or urine content, which will be the subject of this lecture. Using modern methods of rapid analysis, patients can independently evaluate the most important parameters of metabolism with an accuracy close to laboratory. Since these indicators are determined in everyday conditions familiar to the patient, they are of greater value for the correction of therapy than glycemic and glucosuric profiles examined in a hospital or clinic when the patient is in completely different, unusual conditions. The main condition for the prevention and treatment of diabetic microangiopathies is the stable maintenance of a glycemia level close to normal. But only a few patients are able to feel the differences in glycemia from 4 to 10 mmol / l, and it is within these limits that you have to “work” to achieve close to normal blood sugar levels. In addition, patients with prolonged decompensation adapt to hyperglycemia and feel satisfactory, and their reduction to normal is perceived at the first stages of treatment as hypoglycemia. Therefore, one cannot rely on subjective feelings when trying to achieve normoglycemia.

Problems of Endocrinology. 1994;40(1):36-39
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Experimental endocrinology
Steroid hormone and noradrenalin effects on somatotropic hormone secretion by primary cultures of hypophyseocytes of rats of different ages
Gudoshnikov V.L., Mamaeva T.V., Fedotov V.P.
Abstract

Dexamethasone and aldosterone in concentrations 10-8 to 10-6 stimulated STH secretion by hypophyseal cells of neonatal and adult rats under conditions of prolonged (72 h) incubation of primary cultures. Corticosterone and progesterone had a stimulating effect on STH release by hypophyseal cells. Long exposure of cultured suckling rat cells to dexamethasone resulted in increase of STH basal secretion and enhanced the stimulating effect of low concentration (10-7 mole) of noradrenalin on STH release during a subsequent shdrt (2 h) incubation. The results permit us to suggest that development of hypophyseal somatotropic function observed in the postnatal period may be to a certain measure explained by combined effects of corticosteroids and catecholamines.

Problems of Endocrinology. 1994;40(1):39-41
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Body niacin status in diabetes mellitus: Effect of protein level in a ration
Sadykova R.Y., Kodentsova V.M., Dreval A.V.
Abstract

Administration of a high-protein diet providing 7-7.8 g of tryptophan per kg of the ration to rats with streptozotocin and alloxan diabetes mellitus resulted in development of a trend to increased liver content of nicotinamide coenzymes and in increased 1-methylnicotinamide excretion with the urine in both groups of animals, this reflecting increased niacin synthesis from tryptophan. Sugar-reducing effect of high-dose nicotinamide was not potentiated by increase of protein share in the ration. These results permitted the authors to suggest that intensification of endogenous niacin synthesis from tryptophan contained in the ration may be one of the mechanisms of a protective effect of high- protein diets in diabetes.

Problems of Endocrinology. 1994;40(1):41-43
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Basal and LH-RH-stimulated gonadotropin secretion in oophorectomized female rats with streptozotocin-induced diabetes
Babichev V.N., Adamskaya Y.L., Peryshkova T.A.
Abstract

In vitro insulin effect on basal and LH-RH- stimulated gonadotropin secretion in oophorectomized female rats with streptozotocin diabetes administered estradiol as replacing hormone therapy was studied. The results were compared to those obtained after a similar incubation of adenohypophyses of oophorectomized rats and of oophorectomized rats administered estradiol. Estradiol was found to change the type of LH-RH-stimulated gonadotropin secretion in oophorectomized animals. Basal, but not LH-RH-stimulated gonadotropin secretion, was increased in rats with experimental diabetes as against other groups. Insulin inhibited basal and increased LH-RH-stimulated gonadotropin secretion in oophorectomized rat’s with streptozotocin diabetes administered estradiol. A conclusion is made about impaired sensitivity of hypophyseal gonadotrophs to LH-RH in streptozotocin diabetes and about a possible contribution of insulin to regulation of body reproductive system at the level of hypophysis.

Problems of Endocrinology. 1994;40(1):43-46
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Analysis of hypothalamo-hypophyseo-gonadal relationships in female rats with experimental diabetes
Babichev V.N., Adamskaya Y.L., Peryshkova T.A.
Abstract

Hypothalamo-hypophyseo-gonadal system functional activity was studied in rats with streptozotocin diabetes. In intact rats concentrations of sex hormones nuclear receptors were measured in the hypothalamic preopticoanterior, mediobasal segments and in the adenohypophysis, as were blood serum gonadotropins and sex hormones. Estradiol and progesterone were injected to ovariectomized females and LH-RH levels measured in preopticoanterior segment of the hypothalamus, arcuate nucleus, and median eminence, as well as LH and FSH concentrations in the blood in order to detect disorders in basal and cyclic gonadotropin secretion. Streptozotocin injection to cycling females disordered the estral cycle and was associated with reduction of LH, FSH, and sex hormones basal and cyclic secretion. Estradiol nuclear receptors concentrations reduced in the preopticoanterior hypothalamus and hypophysis, the count of nuclear testosterone-binding sites reduced only in the hypophysis. Gonadotropin wave stimulated with sex steroids in ovariectomized females was reduced in diabetes because of changed activity of LH-RH-producing system. We believe that changes in basal and cyclic secretion of gonadotropins in rat females with experimental diabetes is explained by reduced activity of LH-RH-producing system and receptor binding at the level of the hypothalamo-hypophyseal complex.

Problems of Endocrinology. 1994;40(1):46-50
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Thyroid morphology and function in rat strains selected for nervous system excitability
Dmitriyeva N.I., Idrisova D.A., Vaido A.I., Shiryayeva N.V., Arutynian N.A., Lopatina N.G., Shalyapina V.G.
Abstract

Thyroid morphology, function, and hormonal levels were studied in two rat strains with genetically determined levels of nervous system excitability immediately and in late periods after prolonged stress resulting in development of a neurosis-like state. A high resistance of the linear characteristics of thyroid morphology and function was revealev whose high functional activity was observed in the rats with a low excitability threshold. Two weeks after neurotization cessation morpho- functional status of the thyroid normalized.

Problems of Endocrinology. 1994;40(1):50-52
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Reviews
Reproductive function in women with insulin-dependent diabetes mellitus
Matveyeva L.S., Berdyklycheva A.A., Strekolshikova O.D.
Abstract

In recent years, there has been increasing scientific interest in studying reproductive disorders in patients with diabetes mellitus (DM), which is associated with advances in the treatment of the disease, which can significantly increase the life expectancy of patients with diabetes, maximally delay the onset and progression of severe complications of the disease, as well as that the risk of insulin-dependent diabetes mellitus (IDDM) in the offspring was much lower than previously thought.

A fairly high frequency of menstrual irregularities, infertility, an increase in the pathology of pregnancy and childbirth, and a significant reduction in the fertility period in women with diabetes mellitus are noted in the literature.

Similar violations are found, according to literature 1'01. In ’/ 3 sick women. Amenorrhea in women of reproductive age is observed 2 times more often than in the population. Spontaneous abortions were noted 1.3 times more often, the birth rate in patients with diabetes is 1.59, while normally it is 1.89.

Problems of Endocrinology. 1994;40(1):52-56
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Immunologic aspects of autoimmune thyroiditis
Kalinin A.P., Potemkina Y.Y., Pesheva N.V., Rafibekov D.S.
Abstract

Autoimmune thyroiditis (AIT) is one of the most important and relevant problems of modern endocrinology due to the lack of study of the etiology, lack of clarity of pathogenetic mechanisms, and the absence of objective and reliable diagnostic methods, including immunological ones.

The last decade is characterized by the appearance of fundamental works devoted to the immunology of autoimmune thyroid diseases. The data need generalization, a critical analysis, since the conclusions of the authors often differ in inconsistency.

AIT takes first place among thyroid diseases. According to V.I. Litvinov, AIT is observed in 20-40% of the adult population, according to foreign authors, in 7.2% of the children. In 90% of cases, hypothyroidism in adults is caused by autoimmune processes, of which 70% is associated with AIT.

The prevalence of the disease is primarily associated with a catastrophic environmental degradation. There are separate studies suggesting that factors associated with urbanization can contribute to the emergence of AIT. M. Podleski et al., N.I. Romanyuk, I.D. Levit revealed a greater incidence of AIT in the urban population compared with the rural one. The effect of iodine on the incidence of AIT is widely studied: a deficiency of a trace element helps to reduce it, and an excess increases it. In the occurrence of AIT, the role of radiation is significant. So, in territories affected by radiation as a result of accidents, AIT is registered 2 times more often (19.2% versus 8.8% in uncharged territory). N.V. Romashkan et al. they associate an increase in the incidence of AIT with increasing general allergization of the population, a significant recent prevalence of viral infections that enhance autoimmunization. The function of the thyroid gland, the peripheral phenotype of T cells and their function are affected by smoking. Nicotine can damage thyroid cells and release thyroglobulin into the blood, and also directly affect the function of T-suppressors.

To date, there are three hypotheses for the pathogenesis of AIT: antigenic damage to the thyroid gland, a defect in specific T-suppressors, and a violation of the regulatory function of thyroid-stimulating hormone. None of the hypotheses is conclusively confirmed. It is possible that all three mechanisms are involved in the emergence and formation of an autoimmune specific process, clinically manifesting themselves in various stages and forms of the disease.

Problems of Endocrinology. 1994;40(1):56-58
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Peer-REVIEW
I. I. Dedov, V. I. Dedov. Hormonal Biorhythms
Lyashuk P.M., Pishak V.V.
Abstract

There are many different, mostly popular, sometimes sensational publications dedicated to biorhythms in our lives. The peer-reviewed monograph summarizes literature data and the results of our own studies on the nature of the rhythmic functioning of various parts of the neuroendocrine system and the role of hormone biorhythms in the development of endocrinopathies. The authors went beyond the title of the book, since biorhythms are only a special case of a wider dependence of life processes on time.

The monograph consists of a preface, introduction, 4 chapters, conclusion and list of references. The introduction substantiates the relevance of the topic and clearly defined tasks. The material of each chapter is presented at the modern level of knowledge with an analysis of extensive, mainly foreign, literature.

Problems of Endocrinology. 1994;40(1):58-59
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Current Events
Research and practical conference of endocrinologists of the Armed Forces
Yakovlev V.A., Shustov S.B.
Abstract

In June 1993, the All-Army Scientific and Practical Conference of Endocrinologists was held in St. Petersburg, dedicated to the memory of Professor D. Ya. Shurygin, Honored Scientist of the Russian Federation, who for a long time headed the endocrinological service of the Armed Forces. The conference was organized by the medical service of the Armed Forces of Russia and the Military Medical Academy.
The conference was attended by the chief therapist of the Ministry of Defense of the Russian Federation, corresponding member. RAMS V.T. Ivashkin, endocrinologists of the Military Medical Academy and central military hospitals, a number of leading scientists and endocrinologists of the country from Moscow, St. Petersburg, Saratov and Yekaterinburg, as well as some specialists from neighboring countries. The conference lasted 2 days and consisted of 3 plenary sessions, at which 22 reports were heard. Other participants who submitted abstracts of messages (more than 130 people) could present materials in the form of poster presentations. Conference proceedings published.

Problems of Endocrinology. 1994;40(1):59-59
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Anniversary
V. V. Potemkin (on the occasion of his 60th birthday)
 
Abstract

60 years have passed since the birth of the famous endocrinologist, head of the department of endocrinology of the Russian State Medical University, Professor Vladimir Vasilyevich Potemkin.

In 1951, V.V. Potemkin entered the Leningrad Military Medical Academy. S. M. Kirova, at the end of which he worked as a military doctor. In 1960, he was admitted to clinical residency at the Department of Endocrinology of the Institute for Advanced Medical Studies, after which he was enrolled in the graduate school of the same department. During this period, V. V. Potemkin defended his thesis on the topic “The relationship of carbohydrate and lipid metabolism in diabetes mellitus and their clinical significance.”

Since 1965, V.V. Potemkin's pedagogical, scientific and medical activities are fully connected with the Russian State Medical University (2nd Pirogov Moscow Medical Institute).

V.V. Potemkin is a talented teacher and scientist, one of the leading endocrinologists in our country. 60 years have passed since the birth of the famous endocrinologist, head of the department of endocrinology of the Russian State Medical University, Professor Vladimir Vasilyevich Potemkin.

In 1951, V.V. Potemkin entered the Leningrad Military Medical Academy. S. M. Kirova, at the end of which he worked as a military doctor. In 1960, he was admitted to clinical residency at the Department of Endocrinology of the Institute for Advanced Medical Studies, after which he was enrolled in the graduate school of the same department. During this period, V. V. Potemkin defended his thesis on the topic “The relationship of carbohydrate and lipid metabolism in diabetes mellitus and their clinical significance.”

Since 1965, V.V. Potemkin's pedagogical, scientific and medical activities are fully connected with the Russian State Medical University (2nd Pirogov Moscow Medical Institute).

V.V. Potemkin is a talented teacher and scientist, one of the leading endocrinologists in our country.

Problems of Endocrinology. 1994;40(1):60-60
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