[Renal artery stenosis in patients with type 2 diabetes mellitus: clinical signs, diagnosis, prognostic value].

AIM: To define the prevalence, clinical features, risk factors, and prognostic value of atherosclerotic renal artery stenosis (RAS) in patients with type 2 diabetes mellitus (T2DM). SUBJECTS AND METHODS: One hundred and fifty-seven T2DM patients (63 males and 94 females) aged over 50 years were examined. Screening for RAS was carried out by duplex ultrasound scanning (DUSS); the diagnosis was verified by multispiral computed tomography and magnetic resonance imaging. Moreover, the detection rate of RAS was analyzed from the selective angiographic readings of 30 patients with T2DM and 26 coronary angiography patients without DM who had undergone coronary angiography (CA). RESULTS: In the total group of T2DM patients, the RAS detection rate was 36.9%, as evidenced by DUSS and 43.3% by selective renal artery angiography in the patients who had undergone CA. The factors associated with the development of RAS were smoking (relative risk (RR) = 3.3; p < 0.001); atherosclerosis of coronary (RR = 4.28; p < 0.001) and peripheral (RR = 3.38; p < 0.02) arteries, isolated systolic hypertension (RR = 3.9; p < 0.01), and anemia (RR = 6.4; p < 0.001). In patients with T2DM, RAS was one of the important factors of progressive renal and cardiac diseases and increased mortality determined by the combined end point: death, emergency hospitalization for heart failure, myocardial infarction, double creatinine, and end-stage renal failure (RR = 6.28; p < 0.001). CONCLUSION: The optimization of prognosis in T2DM patients with RAS requires its timely clinical identification in combination with other types of renal lesion, aggressive correction of the mechanisms of the progressive process, and development of medical and endovascular therapies.

[Attempt to use the genetically engineered growth hormone SAIZEN in children with somatotropic insufficiency: results of clinical trials in Russia]. / Opyt ispol'zovaniia genno-inzhenernogo gormona rosta SAIZEN dlia lecheniia detei s somatotropnoi nedostatochnost'iu: rezul'taty klinicheskoi aprobatsii v Rossii.

The efficacy and safety of SAISEN, a recombinant human growth hormone obtained from mammalian cells, was tested in children with hypophyseal nanism. The treatment duration was 1 year. The results indicate that SAISEN (ARES-SERONO) is a highly effective and safe preparation of growth hormone, noticeably stimulating the growth rate both in previously untreated children with somatotropic insufficiency, and in those previously treated with STH preparations. Therapy with SAISEN was not associated with any side effects, as shown by both clinical and laboratory data.

[Computed tomographic diagnosis of substernal goiter]. / Komp'iuterno-tomograficheskaia diagnostika zagrudinnogo zoba.

The authors analyze the results of computer-aided tomographic (CAT) diagnosis in 25 patients with restrosternal goiter. They claim that CAT is a method of choice in the preoperative diagnosis of retrosternal goiter, permitting the solution of a problem on the volume of surgical intervention and of the type of anesthesia. CAT helps specify the site, size, and dissemination of goiter beyond the sternum and assess its relations with the adjacent organs and tissues.

[Osteopenic syndrome in liquidators of the aftereffects of the accident at the Chernobyl power plant]. / Osteopenicheskii sindrom u uchastnikov likvidatsii posledstvii avarii na Chernobyl'skoi atomnoi élektrostantsii.

Bone system was examined in 112 liquidators; in 71 of these osseous tissue density was studied by osseous densitometer using bienergetic x-ray absorptiometry and in 45 x-ray examinations, analyses of biochemical and hormonal parameters were carried out. Spinal painful syndrome was detected in 61 to 82% of the examinees. For analysis of densitometric and x-ray parameters the liquidators were divided into 2 groups: group 1 included those who worked at the power plant in 1986 (55%) and group 2 were those who worked there in 1987-1989. Radiation doses in group 1 reliably surpassed those in group 2 (p < 0.001). Bone mineral density in the lumbar vertebrae was significantly lower in group 1 as against group 2 and lower in both groups vs. controls. More than 5% osseous mineral loss was revealed in 73% of group 1 liquidators and in 43% of group 2 ones. Analysis of spinal roentgenograms in 45 liquidators showed a high incidence of negligible and moderately expressed osteoporosis without compression fractures of vertebral bodies: osteopenia signs were found in 87% of group 1 examinees complaining of pain in the spine and in 73% of group 2 examinees; signs of osteochondrosis and spondylosis were detected in 40% of group 1 and in 47% of group 2 subjects. Hence, a higher incidence of osteopenia in liquidators, more manifest condition and its higher detection rate in subjects exposed to higher radiation doses indicate a certain contribution of radiation factor to the development of the osteopenia syndrome in liquidators.

[Pathogenesis of thyroalgia]. / K patogenezu tireoalgii.

The authors analyze thyroalgias occurring in various thyroid diseases and diseases of the adjacent organs and tissues. They come to a conclusion that as far as thyroid diseases are concerned, true thyroalgias are the most incident in various thyroiditis forms, thyroid tumors, postoperative cicatrices, and are explained by the pathologic process impact on glandular capsule (stretching, intergrowth, pressure, etc.). Of diseases not directly related to thyroid but causing thyroalgias (pseudothyroalgias) laryngitis, pharyngitis, and osseous conditions are the most incident, which indirectly influence pain development. Pseudothyroalgias should be differentiated from such osseous changes in the neck as deforming spondylosis, spondylarthrosis, extra cervical ribs (a developmental abnormality), and structural specificities of temporal bone styloid processes.

[Comparative assessment of conservative therapy methods in patients with the diabetic foot syndrome]. / Sravnitel'naia otsenka metodov konservativnoi terapii bol'nykh s sindromom diabeticheskoi stopy.

Fifty patients with types I and II diabetes complicated by the diabetic foot syndrome were examined. The patients were divided into two groups: Group I patients were administered x-ray therapy of the feet and shins, group 2 ones were treated by angioprotectors and antiaggregants. Complaints and objective data, findings of ultrasonic examination of the lower limb vessels and biothesiometry, x-ray picture before and 6 months after the treatment were assessed. 36 normal subjects made up the control group. The authors emphasize a marked effect of x-ray therapy as against drug treatment.

[Comparison of diagnostic methods for osteoporosis in endogenous hypercorticism]. / Sravnitel'naia kharakteristika metodov diagnostiki osteoporoza pri éndogennom giperkortitsizme.

The informative value of diagnosis of osteoporosis in 53 patients with Itsenko-Cushing disease was assessed by visual estimation of radiograms of the axial skeleton, standard x-ray densitometry of the phalanges of the thumbs and single-photon absorptiometry of the distal parts of antebrachial bones. Diagnosis of osteoporosis and its evaluation over time were shown to be accurate in combination of visual assessment of radiograms of the axial skeleton with standard x-ray densitometry of the peripheral parts of the skeleton. Single-photon absorptiometry revealed no decrease in the level of the osseous mineral in the forearm of patients with endogenous hypercorticoidism. In the majority of female patients this indicator even exceeded the normal age value. Possible causes of this phenomenon are under discussion.

[Possible mechanisms of the development of osteopaties in patients with chronic lead poisoning]. / Vozmozhnye mekhanizmy vozniknoveniia osteopatii u bol'nykh khronicheskoi svintsovoi intoksikatsiei.

Osseous tissue conditions were studied against changing clinical manifestations of chronic intoxications with lead. In more than 50% cases, hypertrophic osteoporosis was revealed. 65% cases were marked with osteoarthrosis deformans of the elbow and knee joints. The contributors review the local and general hormonal mechanisms underlying osteopathy caused by lead intoxications.

[The efficacy of proton irradiation of the hypophysis in children with Itsenko-Cushing disease]. / Effektivnost' protonnogo oblucheniia gipofiza u detei s bolezn'iu Itsenko-Kushinga.

The authors represent the results of the treatment of 20 children with Itsenko-Cushing disease (ICD) by proton-beam irradiation of the pituitary body. The use of the medical proton beam of the Institute of Theoretical and Experimental Physics was found to be effective for the treatment of children with mild and average forms of ICD. Irradiation of the pituitary gland at a dose of 70-100 Gy is accompanied by general and local radiation reactions which are not dangerous for children. The time of development of remission after irradiation depends on a degree of severity and features of a course of disease.

[The clinical x-ray characteristics of the soft tissues of the lower extremities in diabetics]. / Kliniko-rentgenologicheskaia kharakteristika miagkikh tkanei nizhnikh konechnostei u bol'nykh sakharnym diabetom.

The authors present the results of clinicoroentgenological and immunological investigations of the state of lower limb soft tissues in 117 patients with diabetes mellitus. Vascular wall calcification and soft tissue edema were noted practically in all the patients with a period of disease over 1 year. X-ray investigation permitted the detection of vascular lesion at early stages of complication development, in most of the patients even at the preclinical stage. A degree of lower limb vascular lesion is not related to a type of diabetes mellitus and the patients' age. There is direct correlation between the affection of the walls of medium size vessels and vessels of the fundus of the eye. The frequency and severity of lower limb vascular lesion, polyneuropathy and nephropathy grow significantly with an increase in a period of disease. A parallel decrease of immunoglobulins is noted. The affection of osseous tissue does not depend on a period of disease and shows insignificant correlation with a degree of vascular lesion.

[The soft tissues of the foot in acromegaly]. / Sostoianie miagkikh tkanei stopy pri akromegalii.

X-ray investigation of foot soft tissues and measurement of foot soft tissue thickness (FSTT), clinical examination and determination of the level of plasma STH were performed in 43 previously untreated patients with acromegaly and in 9 patients in clinical remission. The results obtained suggest that elevated FSTT over 22 mm and changes in foot soft tissues are characteristic for acromegaly. A conclusion is that determination of the state of foot soft tissues and a FSTT value can serve as an auxiliary sign for the diagnosis of early stages of disease as well as for the assessment of a degree of activity and efficacy of long-term results of therapy of acromegaly.

[Comparative evaluation of the effectiveness of vitamin D3 preparations (1-alpha-hydroxy- and 1-alpha,25-dihydroxycholecalciferol in various forms of osteoporosis and osteomalacia]. / Sravnitel'naia otsenka éffektivnosti preparatov vitamina D3 (1-alpha- i 1-alpha,25-dihydroxycholecalciferol) pri razlichnykh vidakh osteoporoza i osteomaliatsii.

Clinical investigations have shown that 1 alpha-hydroxycholecalciferol (oxydevit, alphacalcidiol) and 1 alpha, 25-dihydroxycholecalciferol (rocaltrol) are act vitamin D3 agents producing a positive clinical effect in different types of osteoporosis and osteomalacia. Clinical improvement of the patients' status (alleviation of the pain syndrome, an increase in motor activity) was noted in 1-2 mos., an x-ray picture of regeneration of the bone structure of both axial and peripheral skeleton--in 6-12 mos. after the initiation of therapy. Therapy was attended by an increase in the serum content of total and ionized calcium, the return of alkaline phosphatase activity to normal, and a decrease in the level of parathormone. During prolonged therapy these agents administered at daily doses of 0.25-2 micrograms caused no pathological side-effects and hypercalcemia. In osteoporotic conditions all these drugs were equal in their clinical effectiveness. Rocaltrol has some advantages in the presence of associated liver pathology.

[Radiotherapy in the treatment of children with Itsenko-Cushing's disease]. / Luchevaia terapiia v lechenii bolezni Itsenko-Kushinga u detei.

Forty children with Icenko-Cushing's disease were subjected to radiotherapy. Radiation of the pituitary with a proton beam in a dose of 70-100 Gy (7000-10000 rad) performed according to the indicated technique appeared highly effective. It was not associated with local or total radiation injuries and was safe. X-ray therapy conducted according to the fractionally intensive technique in a dose of 3000-3500 rad was less effective and produced disease relapses more frequently as compared with proton therapy.

[Involutional osteopathies: the clinical x-ray, biochemical and hormonal aspects of the diagnosis]. / Involiutsionnye osteopatii: kliniko-rentgenologicheskie, biokhimicheskie i gormonal'nye aspekty diagnostiki.

A study of patients with involution osteopathy has shown that the development of this disease is associated with osseous tissue dystrophic changes (osteoporosis) and, to a lesser extent, with osteomalacia. Involution osteopathy is not accompanied by severe changes in indices of phosphoric-calcium metabolism; it is characterized by a tendency to an increase in the levels of total and ionized calcium and a decrease in the level of serum phosphorus. A lowered level of calcitonin with a tendency to a decrease in the level of the somatotropic hormone and the unchanged content of parathormone was revealed in involution osteopathy. The blood level of sex steroids (both estradiol and testosterone) in women was decreased, a degree of a rise of gonadotropins in them was lower than that in healthy postmenopausal women. In men with involution osteopathy the mean level of serum testosterone was within low normal limits, the LH content remained normal, and a FSH level was raised. The level of prolactin in patients of both sexes was unchanged.