[The thyroidal status in childbearing-aged women living in a moderate iodine-deficient area].

The thyroidal status of childbearing-aged females who had no manifest thyroid pathology and lived in a moderate iodine-deficient region was studied 6 years after resumption of lodine prevention.

Gestational hypothyroxinemia and cognitive function in offspring.

The effects of gestational hypothyroxinemia on the neurointellectual prognosis of children in the first year of life living in an industrial city (megalopolis) with mild iodine deficiency were studied in 13 children of mothers with thyroid hormone-corrected gestational hypothyroxinemia in the first trimester and 10 children of mothers with normal levels of free thyroxine by assessing cognitive functions at ages six, nine, and 12 months using the Gnome mental development scale. The results showed that maternal free thyroxine levels at the early stages (5-9 weeks) of pregnancy correlated significantly with the coefficients of mental development among the children at ages 6, 9, and 12 months, i.e., represented one of the factors defining the neuropsychological development of offspring. Early (not later than nine weeks) correction of gestational hypothyroxinemia with levothyroxine at a mean daily dose of at lest 1.2 microg/kg improved the neurointellectual prognosis of the offspring, increasing the coefficient of mental development of children to 92-97 points during the first year of life, i.e., to the level of development of mental functions of children born to mothers with normal thyroxine levels.

[Iodine prophylaxis and the health status of infants of the first year of life, living in a mild iodine-deficiency industrial megapohs].

Adequate iodine prophylaxis in women living in an iodine-deficiency region, startingfrom early pregnancy, positively affects its course and in their babies' neonatal period, somatic and psychoneurological status (increased the mean neuropsychological status by 4-5 scores, by Improving the parameters of cognitive functions). This necessitates the use of potassium iodine agents in a dose of at least 200 fig/day, as recommended by the WHO (2001), in all early pregnancy women living in an iodine-deficient region.

[Gestational hypothyroxinemia and cognitive functions of offsprings].

То study the impact of gestational hypothyroxinemia on the neurointellectual prognosis in infants living in an industrial megapolis who had mild-to-moderate iodine deficiency, the authors used a "Gnome" mental development scale to assess cognitive function in 13 babies bom to mothers who had first-trimester gestational hypothyroxinemia corrected with thyroid hormonal preparations and in 10 babies born to mothers who had normal free thyroxine levels when the babies were 6,9, and 12 months old. The study indicated that the maternal level of free thyroxine in early (at weeks 5-9) pregnancy significantly correlated with the mental development index of babies at the age of 6,9, and 12 months, i.e. it is one of the determinants of offspring's nervous and mental development. Moreover, early (not later than 9 weeks of pregnancy) correction of gestational hypothyroxinemia with levothyroxine in a mean daily dose of at least 1.2 fig/kg improves the prognosis of progeny's neurointellectual prognosis, by increasing the mental development index up to 92-97 scores in babies in the first year of life, which are consistent with that in babies bom to mothers having normal thyroxine levels.

[The role of hormone analysis in the nosologic diagnosis and in the control of treatment of congenital primary hypothyroidism]. / Rol' gormonal'nogo analiza v nozologicheskoi diagnostike i v kontrole terapii vrozhdennogo pervichnogo gipotireoza.

A total of 125 children and teenagers, aged 1 to 15 (including 74 patients with primary congenital hypothyroidism--CH--and 51 healthy children), were investigated in the city of Moscow for the purpose of elaborating new approaches towards the differentiated diagnostics of CH and of optimizing the assessment of the adequacy of its substitutive hormonal therapy (SHT). The concentrations of the thyrotropic hormone (TTH), free fractions of triiodothyronine and thyroxin (cT3 and cT4), thyreoglobulin (Tg) and of thyreoid peroxidase (hard-phase test-tube method, electro-chemiluminescent reaction, i.e. magnetic microparticles, based on the streptovidin-biotin technology; ruthenium mark at the "Elecsys 1010" analyzer with reagents manufactured by "F. Hoffman--La Rosh Ltd.", Switzerland.) were determined early in the morning on the empty stomach. On the basis of the above mentioned, the thyroid reserve index (TRI = Tg/TG), integral thyroid index (ITI = [cT3 + cT4]/TTG), and the integral of peripheral conversion (IPC = cT3/cT4) were calculated. The thyroid gland (TG) was visualized by the "Acuson-128 XP" ultrasonic device, "Acuson Corp.", USA, with a linear sensor of 10 Mhz, as well as by the "Toshiba-90B" gamma-chamber, Japan, with a low-energy collimator in 24 hours after an oral intake of sodium iodide marked by the iodine 123-isotope with an activity of 50 Mbc and after the cessation of SHT 3 to 5 weeks before. The complex diagnosis revealed 8 variations of primary CH; aplasia and TG dystopia and defects of the synthesis of the sodium-iodine symporter or Tg-concentration were found to belong to the most severe disease types according to hormonal parameters. As for Tg, in 52% of cases it was normal, undeterminable--23% and higher--25%. A simultaneously implemented ultrasonic scanning (USS) ensured a final diagnosis in subgroups, respectively, in all cases, in 25% and in 75% of patients. On the whole, after the two diagnostic stages (Tg + USS/ITR), the indications for isotope scanning left only for 23% of CH patients, i.e. a) if the Tg values could not be determined because the organ was not located in its typical place (17%); or b) if the Tg level was higher or if there was a goiter at the TG normal volume (6%). An in-depth hormonal analysis showed that, should CHT be monitored less than once in three months, it failed to secure a total compensation of the disease in above one third of CH children (39%). Therefore, a three-stage algorithm of nosological diagnostics is recommended for primary CH; it should comprise the determination of Tg level, and USS (for all patients) as well as TG scanning (according to rare indications). The result point at the necessity of hormonal monitoring of CH children and teenagers at least one in 2-3 months. The objectivity degree of CHT goes up as a number of estimated indices, i.e. ITI and IPC, are used alongside with absolute hormonal values.

[Neurohumoral effect of xenon]. / Neirogumoral'nyi éffekt ksenona.

Clinical trials were carried out in 44 patients during cholecystectomies. The patients were divided into 2 groups (22 pts each) receiving (1) Xe:O2 (70:30) or (2) N2O:O2 (70:30) + phentanyl (0.1 ml boluses every 20 min). Neurohumoral parameters (ACTH, hydrocortisone, STH, prolactin, aldosterone, insulin) were almost identically activated in both groups. However, Xe monoanesthesia provided an anabolic pattern and better preserved the defense mechanisms of the organism in comparison with N2O + phentanyl anesthesia. Moreover, the STH/hydrocortisone ratio was 2-fold higher in the Xe group vs. N2O + phentanyl group. The activities of thyroid hormones (TSH, T3, T4) fluctuated within the normal range, which was indicative of adequate phases of anesthesia in both groups. The parameters of central hemodynamics and metabolism also indicated sufficient depth of anesthesia.

Effects of low level radiation from the Chernobyl accident in a population with iodine deficiency.

UNLABELLED: To determine the effects of low dose radiation from 131I and 137Cs resulting from the Chernobyl disaster on the expression of endemic goiter in children, we studied children in regions with and without evidence of radiocontamination but comparable iodine insufficiency. We included 89 children in the study (radiocontaminated) region (SR) and 116 in the control region (CR) because they were either fetuses, infants, or pre-adolescents at the time of exposure. We evaluated thyroid dimensions by clinical examination and ultrasound; thyroid function by hormonal levels, and thyroglobulin measurement; histology of the thyroid by fine needle aspiration; and thyroid autoimmunity. SR subjects had 5 times the frequency of thyroid enlargement as those from CR, greatest in the younger patients. There were no instances of clinically apparent thyroid dysfunction. Antithyroid microsomal and antithyroglobulin antibodies were present in a markedly greater percentage of SR subjects. Fine needle biopsy demonstrated greater cellular proliferation in samples from SR. CONCLUSIONS: We have demonstrated findings of autoimmune thyroid disease at markedly increased frequency in a population of children with poor iodine nutriture who were exposed to low level radiation, compared to a more iodine deficient population not so exposed. These results suggest that low level radiation may induce thyroid gland changes in children who have inadequate iodine intake nutriture and reinforce the importance of adequate dietary iodine.

[Comparative assessment of the hormonal status during N2O and xenon anesthesia using similar methods]. / Sravnitel'naia otsenka sostoianiia gormonal'nogo fona pri odnotipnoi metodike anestezii N2O i ksenonom.

The hormonal status of 38 surgical patients during anesthesia with nitrous oxide and Xe administered by similar methods showed that in contrast to anesthesia with N2O, Xe anesthesia helped not only preserve the adaptive potential, but even increase the defense potential of the organism during surgery. Xe anesthesia was associated with a 1.5 times less requirement in fentanyl, with the levels of stress hormones being better; Xe is the best alternative to nitrous oxide.

[Renin-angiotensin and hypophyseo-adrenal systems in children suffering from congenital adrenocortical hyperplasia resulting from 21-hydroxylase deficiency]. / Renin-angiotenzinovaia i gipofizarno-nadpochechnikovaia sistemy u detei, stradaiushchikh vrozhdennoi giperplaziei kory nadpochechnikov vsledstvie defitsita 21-gidroksilazy.

A study was made of the activity of plasma renin (APR), and the blood levels of ACTH, 17-hydroxyprogesterone (17-OHP) and aldosterone (A) in 50 children suffering from congenital adrenocortical hyperplasia as a result of 21-hydroxylase deficiency; 38 girls and 12 boys aged 1.5 mos. to 14 years were divided into 2 groups: (1) 35 with a salt losing type of disease; (2) 15 with a common virile type of disease. ARP in the 1st group did not exceed the control values and was unaccompanied by adequate secretion of A. Moderate ARP in parallel with a high level of A was noted in the 2nd group. Mineral corticoid therapy resulted in reduced ARP and A concentration, and a tendency to a decrease in the levels of ACTH and 17-OHP was noted. Variations in ARP and in the level of A did not manifest themselves clinically and were unaccompanied by electrolytic disorders. In the authors' opinion, a choice of adequate therapy for both types of disease must be based on the results of investigation of the above hormonal parameters.

[Secretion of thyrocalcitonin and parathyroid hormone in diffuse polyposis of the colon]. / Cekretsiia tireokal'tsitonina i paratgormona pri diffuznom polipoze tolstoi kishki.

The article presents data obtained in studying the content of calcium regulating hormone thyrocalcitonin and parathyroid hormone in blood plasma of patients with diffuse polyposis of the colon prior to and after a radical surgical treatment. The content of these hormones was also studied in extracts from colonic polyps. The concentration The concentration of thyrocalcitonin was found to decrease after operation. The elevated concentration of thyrocalcitonin was established in polyp extracts which might suggest its "ectopic secretion" in the polyp tissue in diffuse polyposis. Removal of the colon with polyps is followed by normalization of metabolism in the organism which proves the expediency of early surgical treatment.

[Autoimmune processes in the pathogenesis of juvenile thyroid enlargement]. / Autoimmunnye protsessy v patogeneze iuvenil'nogo uvelicheniia shchitovidnoi zhelezy.

The frequency of juvenile thyroid enlargement in Moscow adolescents over the last 25 yrs increased twice, among them in girls three times. During examination of 66 adolescents with juvenile thyroid enlargement without clinical signs of disorder of its function autoimmune processes in the thyroid were revealed in 62%, autoimmune thyroiditis in 15%. Pathogenetic interrelationship between a rise of the frequency of juvenile thyroid enlargement and a rise of autoimmune processes in the thyroid in Moscow adolescents has been assumed. Dispensarization of children with juvenile thyroid enlargement threatening the development of autoimmune thyroiditis was found necessary.

[Status of the hypophysis-adrenal cortex system during treatment with glucocorticoids by the method of intermittent (every other day) administration]. / Sostoianie sistemy gipofiz-kora nadpochechnikov pri lechenii gliukokortikoidami metodom preryvistogo (chrezdnevnogo) vvedeniia preparatov.

The authors discuss the advantages of the use of glucocorticoids in the treatment of autoimmune diseases, if the drugs are administered every other day. A total of 149 patients with autoimmune thyroiditis, endocrine ophthalmopathy, myasthenia and bronchial asthma were examined. Of these, 3 patients received glucocorticoids every other day, whereas the remainder took them every day. The former method consisted in the use of a single daily dose of glucocorticoids (20 to 80 mg) at 7 to 8 o'clock in the morning over 2 months to 5 years. The function of the pituitary-adrenal system was tested by the measurement of the blood content of ACTH, hydrocortisone and testosterone with the aid of a kit of standard tests. It was shown that glucocorticoids administered every other day did not produce any suppression of the pituitary-adrenal system in contrast to those who received prednisolone every day. The lack of the side effects in the form of exogenous hypercorticoidism can be explained by the anabolic action of steroid hormones produced by the reticular zone of the adrenal cortex. Examination of the blood serum content of testosterone in women who received glucocorticoids every other day has demonstrated that modulations in its secretion were similar to those in the content of ACTH and hydrocortisone. Thus, the stimulating hormonal therapy with glucocorticoids administered every other day appears more physiological as compared to the daily schedule.

[Strategy for using glucocorticoid preparations in neuromuscular diseases]. / Strategiia primeneniia gliukokortikoidnykh preparatov pri nervno-myshechnykh zabolevaniiakh.

A total of 1630 patients with various neuromuscular diseases of autoimmune genesis were treated. Glucocorticoid drugs taken every other day were shown to be highly effective. On the basis of a large experience the authors propose recommendations for the management of patients in relation to the form, severity and course of the disease with the objective of achieving the maximum therapeutic effect.

[Long-term use of parlodel in acromegaly]. / Dlitel'noe primenenie parlodelia pri akromegalii.

The authors studied the basal and L-DOPA-stimulated levels of STH and basal level of prolactin in blood serum of 128 patients presenting with acromegaly. The basal levels of STH and prolactin were found to be elevated in the majority of patients with an active disease stage. Long-term (for 5-6 years) therapy with parlodel (2.5-20 mg a day) produced a disease remission. It is concluded that parlodel can be used not only as an additional agent to x-ray therapy or hypophysectomy but also as monotherapy, provided that the drug is applied for a long time.

[Diagnostic problems of autoimmune thyroiditis]. / Voprosy diagnostiki autoimmunnogo tireoidita.

The most informative diagnostic criteria of autoimmune thyroiditis were revealed. A kit of diagnostic tests were offered for each version of autoimmune thyroiditis. The lowest percentage of antibodies against thyroglobulin was demonstrated for the hyperthyroid hypertrophic version of autoimmune thyroiditis, while the highest for its atrophic pattern. Biopsy of the thyroid was found to be the most informative test for autoimmune thyroiditis, provided the result was positive. If the result of puncture biopsy is negative, it is desirable to apply a complex of tests depending on thyroid function and size.

[Efficacy and adverse effects of using large doses of corticosteroid preparations administered every other day]. / Effektivnost' i pobochnye iavleniia primeneniia kortikosteroidnykh preparatov v bol'shikh skheme po cherez den'.

The authors analyze the efficacy and side effects of prednisolone administered to 600 patients for myasthenia and polymyositis in a dose of 0.8 to 1.5 mg per kg body weight every other day for a period ranging from 3 months to 10 years. Practically complete remissions and substantial improvement were attained in 74% of the patients. None of them showed pronounced symptoms of hypercorticism. Of the side effects the most frequent were luniform face, vegetative disturbances, hirsutism. It is shown that the degree of the side effects is associated not with the duration of the prednisolone treatment, but with initially large doses of the hormone. Transition to supporting therapy in a dose of 0.4 to 0.6 mg/kg led to a substantial diminution and disappearance of the corticosteroid-produced side effects.