Prevalence of diabetes mellitus in patients with acromegaly.

Early carbohydrate metabolism disorders (ECMDs) and diabetes mellitus (DM) are frequently associated with acromegaly. We aimed to assess the prevalence of ECMDs in patients with acromegaly and to compare the results with those in adults without acromegaly using two population-based epidemiologic surveys. We evaluated 97 patients with acromegaly in several phases of their disease (mean age, 56 years and estimated duration of acromegaly, 12.5 years). An oral glucose tolerance test was done in those not yet diagnosed with DM to reveal asymptomatic DM or ECMDs (impaired glucose tolerance+impaired fasting glucose). Comparisons were made between patients with acromegaly and participants from the general adult population (n=435) and an adult population with multiple type 2 diabetes risk factors (n=314), matched for gender, age and BMI. DM was diagnosed in 51 patients with acromegaly (52.5%) and 14.3% of the general population (P<0.001). The prevalence of ECMDs was also higher in patients with acromegaly than in the general population and in the high-risk group; only 22% of patients with acromegaly were normoglycaemic. The prevalence of newly diagnosed ECMDs or DM was 1.3-1.5 times higher in patients with acromegaly compared with the high-risk group. Patients with acromegaly having ECMDs or DM were older, more obese and had longer disease duration and higher IGF1 levels (Z-score). Logistic regression showed that the severity of glucose derangement was predicted by age, BMI and IGF1 levels. In patients with acromegaly, the prevalence of DM and ECMDs considerably exceeds that of the general population and of a high-risk group, and development of DM depends on age, BMI and IGF1 levels.

[Peculiarities of pregnancy management after multiple stenting of coronary arteries].

This paper describes the strategy for pregnancy and labour management in women with the history of myocardial infarction after multiple stenting of coronary arteries using stents with cytostatic coating. The authors discuss a broad range of diseases underlying coronary lesions in young pregnant women receiving antiaggregation therapy. Neither multiple stenting nor intake of aspirin and ticlopid provoked teratogenic effect.

Serum interleukin-6 in patients with adrenal tumors.

The mean blood content of interleukin-6 in patients with adrenal tumors was much higher than in healthy donors. No correlations were revealed between interleukin-6 level, patients sex and age, stage and duration of the disease. Interleukin-6 concentration was maximum in patients with adrenocortical cancer. A negative correlation was found between interleukin-6 level and blood cortisol concentration in patients with cortisol-producing adenoma. In patients with aldosterone-producing adenoma, interleukin-6 level tended to correlate negatively with plasma renin activity.

[Glucocorticoid adrenal function and clinical implications of hydrocortisone metabolism tests in patients with bronchial asthma]. / Gliukokortikoidnaia funktsiia nadpochechnikov i klinicheskoe znachenie opredeleniia metabolizma kortizola u bol'nykh bronkhial'noi astmoi.

A glucocorticoid adrenal function was studied in 42 perimenopausal women with bronchial asthma (BA) by radioimmunoassay estimation of blood hydrocortisone levels, free and conjugated fractions of urinary hydrocortisole, 24-h excretion of overall 17-OCS and hydrocortisone metabolism index. Replacement estrogens inhibit processes of microsomal hydroxylation and reduce clearance of the introduced steroids. Replacement therapy with sex hormones conducted to correct menopause had no negative influence on hydrocortisone blood levels and its metabolism.

Plasma content of soluble fas antigen in patients with adrenal tumors and tumor-like pathologies.

We compared plasma content of soluble Fas antigen (sFas) in 59 patients with tumors and tumor-like pathologies of the adrenal cortex and medulla and 60 healthy donors (control). The incidence and content of sFas in the plasma from patients with adrenal tumors was significantly higher than in healthy donors. A direct correlation was found between sFas content and patient's age. The maximum sFas concentrations were found in patients with pheochromocytoma and aldosterone-producing adenoma. In patients with adrenocortical cancer plasma content of sFas was lower than in patients with tumors of other morphological types. Plasma sFas content in patients with adrenocortical cancer directly correlated with the size of tumors. Our results suggest that sFas plays a role in the pathogenesis of primary adrenal tumors.

[Low-flow membrane oxygenation of blood in patients with diffuse purulent peritonitis]. / Malopotochnaiua membrannaia oksigenatsiia krovi pri razlitom gnoinom peritonite.

Small-flow membranous oxygenation of the blood was used in 45 patients with peritonitis in the multiple organ failure phase. In ten cases blood oxygenation was combined with hemofiltration. MOCT 19-03 (Kvant Research and Production Unit) and Gambro FH hemofilters (Sweden) were employed. Combination of small-flow membranous oxygenation of the blood combined with hemofiltration appreciably improved the oxygen-transporting function of the blood in adult patients with the respiratory distress syndrome, which was due to mutual potentiation of the two methods' effects. Small-flow membraneous oxygenation alone improved cellular immunity and decreased the laboratory manifestations of endogenous intoxication due to biotransformation of toxic products.

[The extratumor mechanisms of osteolysis in multiple myeloma and the means for their correction]. / Vneopukholevye mekhanizmy osteoliza pri mnozhestvennoi mielome i puti ikh korrektsii.

In 70 patients with stage III multiple myeloma (MM) the authors studied spontaneous and lipopolysaccharide-induced production of interleukin-1 (IL-1) and interleukin-6 (IL-6) by blood and bone marrow mononuclear cells, concentration of parathyroid hormone and vitamin D3 in the serum. Bone marrow density was measured at photon absorption (Gambro), in patients treated with osteoprotectors bonefos and oxidevit before and after therapy (3.5-6 month course). It is shown that in MM there is a pathogenetic association between production of osteotropic IL-1, IL-6 and bone demineralization. The cases with reduced concentration of Ca and P ions in the serum (4 and 5.7% of patients, respectively) and increased PTH concentration (7%) suggest the existence of new, extratumor mechanisms of osteolysis. It is found that biphosphonates are optimal osteoprotectors. Bonefos (chlodronat, Lieras, Finland) arrests osteolysis proved by a significant increase of bone marrow density and clinical effect.

[Effects of hemofiltration on lipid peroxidation and lipidograms in multiple organ failure syndrome in patients with peritonitis]. / Vliianie gemofil'tratsii na pokazateli perekisnogo okisleniia lipidov i lipidogrammy pri sindrome poliorgannoi nedostatochnosti u bol'nykh peritonitom.

Hemofiltration was used in multiple-modality treatment of 45 patients with peritonitis who developed polyorgan failure. Lipid peroxidation parameters and lipidograms were under study. Lipid peroxidation was activated and supply with alpha-tocopherol drastically decreased. Hemofiltration helped improve the antioxidant defense.

[Individual patient sensitivity to glucocorticoids and hormone resistance in bronchial asthma]. / Individual'naia chuvstvitel'nost' bol'nykh k gliukokortikoidam i gormonorezistentnost' pri bronkhial'noi astme.

The paper reports glucocorticoid actions in bronchial asthma, covers problems of individual sensitivity to glucocorticoids and resistance to hormones, illustrates the dependence of beclometasone dipropionate efficacy on condition of glucocorticoid receptors in alveolar macrophages and clinical appearance of the disease, describes physiological features of patients with hormone-resistant bronchial asthma and its new treatment (extracorporeal photohemotherapy) allowing reduction of prednisolone dose in 14 of 15 patients from 29.6 to 11.4 mg/day, on the average.

[Clinico-biochemical parallels in diverse forms of primary hyperparathyroidism]. / Kliniko-biokhimicheskie paralleli pri razlichnykh formakh pervichnogo giperparatireoza.

Altogether 184 patients with bone, renal or mixed hyperparathyroidism (HPT) presenting primarily were examined for blood levels of parathyroid hormone and indirect indicators of parathyroid function. None of the indices (calcium concentration, phosphorus level, serum activity of acid and alkaline phosphatase, oxyproline excretion with urine, etc.) was changed. The commonest biochemical signs of primary HPT were hypercalcemia, hypersecretion of parathyroid hormone, hyperoxyprolinuria. Biochemical indices deviations occurred more often and were more profound in bone primary HPT and parathyroid adenomas.

[Use of the "extended" minor dexamethasone test in Itsenko-Cushing disease]. / Primenenie "rasshirennogo" malogo deksametazonovogo testa pri bolezni Itsenko-Kushinga.

An increase in the number of diagnostic parameters (in addition to the determination of the urine level of 17-OCS, a study was also made of the level of 17-KS, blood concentrations of ACTH, prolactin, cortisol, and glucose before and after dexamethasone administration at a dose of 0.5 mg every 6 h for 2 days) and strict rules to be observed by examinees prepared for test performance made in possible to raise the differential-diagnostic role of Liddle's minor dexamethasone test. This conclusion was based on the examination of 34 persons without obesity, 25 patients with exogenous constitutional obesity, 75 patients with juvenile pubertal dyspituitarism, 107 patients with hypothalamic obesity, 8 patients with Cushing's syndrome determined by adrenal corticosteroma, one patient with ACTH-ectopic syndrome, and patients with Itsenko-Cushing disease (128 untreated patients, 99 patients with recurrence, 98 patients in remission). The comparison of clinico-instrumental results with the results of the test has shown its informative value for objective assessment of the gravity of disease. Stages of body responses to small doses of dexamethasone (the stage of lost responses, the stage of incomplete loss and the stage of recovered responses) were identified contributing to objective assessment of the gravity, course, presence, recurrence and remission of Itsenko-Cushing disease.

[Itsenko-Cushing disease and lipid peroxidation]. / Bolezn' Itsenko-Kushinga i perekisnoe okislenie lipidov.

In patients with Itsenko-Cushing disease a study was made of the content of lipid hydroperoxides, malonic dialdehyde, alpha-tocopherol in plasma and erythrocytes (in 31 untreated patients, in 41 patients with recurrences, in 61 patients during clinical remission and in 14 patients after bilateral adrenalectomy), in tissue biopsy specimens: of the liver (13), muscles (23), fatty tissue (30). The above indices were studied for comparison in the blood of 36 healthy persons and in tissue specimens of patients with biliary system pathology, pheochromocytomas and corticosteromas. In Itsenko-Cushing disease an elevated level of lipid peroxidation products in plasma, erythrocytes, liver, muscular tissue, and a decrease in the level of alpha-tocopherol in erythrocytes against a background of its elevation in plasma were detected. The level of alpha-tocopherol in tissue biopsy specimens was found to be season-dependent. The data obtained permitted attributing Itsenko-Cushing disease to a group of diseases characterized by the intensification of lipid peroxidation.

[Level of substances reacting with 2-thiobarbituric acid in the plasma of healthy people and patients with various endocrine diseases]. / Soderzhanie soedinenii, reagiruiushchikh s 2-tiobarbiturovoi kislotoi, v plazme krovi zdorovykh liudei i bol'nykh nekotorymi éndokrinopatiiami.

After estimation of the substances reacting with 2-thiobarbituric acid (malonic dialdehyde, MDA) in human blood plasma using a long-term intralaboratory control of the procedure, increase in content of MDA was observed in blood plasma of patients with endocrinopathies, accompanied by obesity, particularly in the patients with Itsenko--Cushing disease (52 patients before treatment and III patients during various steps of complex treatment). The increase in MDA content in blood of these patients appears to occur due to activation of lipid free radical oxidation.