[The vascular wall in postmenopausal women with hypothyroidism and hypertension].

AIM: To study a relationship between thyroid function and the stiffness of great arteries in postmenopausal women with arterial hypertension (AH). SUBJECTS AND METHODS: The trial enrolled 76 postmenopausal patients with clinical hypothyroidism (CHT) (n = 24) or subclinical hypothyroidism (SCHT) (n = 52) and AH; a control group consisted of 40 postmenopausal women with euthyroidism. Body mass index (BMI), waist and hip circumferences, blood pressure (BP), thyroid-stimulating hormone (TSH), free thyroxine, free triiodothyronine, total cholesterol, triglycerides were determines; volumetric sphygmography was performed. Brachial-ankle pulse wave velocity (baPWV) was measured; cardio-ankle vascular index (CAVI) and ankle-brachial index (ABI) were determined. RESULTS: The patients with CHT or SCHT and the controls were matched for age, BMI, BP, and heart rate. TSH levels in patients with SCHT (6.23 (5.27; 8.22) microU/ml) and in those with CHT (11.8 (9.09; 22.7) microU/ml) were statistically significantly higher than in the control group (2.25 (1.5; 2.72) microU/ml) (p < 0.05). BaPWV in the patients with SCHT (14.35 (12.5; 15.5) m/sec) and in those with CHT (13.75 (13.05; 15.25) m/sec) was also statistically significantly higher than in the control group (12.85 (12; 13.9) m/sec) (p < 0.05). Comparison of ABI and CAVI revealed no significant differences between the groups. Univariate analysis of the findings showed a significant impact on higher arterial stiffness in the SCHT and the CHT groups. Total cholesterol levels were significantly higher in the SCHT group than in the control one. CONCLUSION: The patients with AH and hypothyroidism versus their peers with AH and without thyroid function had significant rises in blood cholesterol levels and arterial stiffness. The rise in lipid levels was significantly marked only in the patients with SCHT; and baPWV equally increased in both the SCHT and the CHT groups.

[The role of inflammation factors in development of acute coronary syndrome in patients with type 2 diabetes mellitus and impaired glucose tolerance].

AIM: To study the levels of inflammatory markers in acute coronary syndrome (ACS) and 6 months after its regression in patients with diabetes mellitus (DM) type 2; to evaluate effects of anxiodepressive disorders on inflammatory markers. MATERIAL AND METHODS: The levels of high-sensitive C-reactive protein (hsCRP), interleukin-6 (IL-6), interleukin-18 (IL-18), monocyte-chemmoattractant-protein-1 (MCP-1) and soluble vascular cell adhesion molecules (sVCAM) were measured in blood samples, severity of depressive symptoms and the level of glycated haemoglobin (HbA1c) were assessed in 58 patients with type 2 DM during ACS and in 54 patients 6 months after ACS regression. RESULTS: The levels of hsCRP and IL-18 correlate significantly with severity of myocardial lesion in ACS (p < 0.002; p < 0.009). Measurement of inflammatory markers 6 months after the discharge from hospital shows significant correlation between hsCRP, IL-18 and IL-6 levels; these levels were significantly lower in patients with HbA1c < 6.5% (tight glycemic control); there were associations between severity of depressive disorders and markers of inflammation (hsCRP, IL-18); analysis of MCP-1 and sVCAM levels 6 months after ACS regression shows a decrease of markers in 32-36% cases and an increase of markers in 64-67% cases. CONCLUSION: Complex immunological reactions, chronic hyperglycemia and depresssive disorders play an important role in development of latent inflammation of the vascular wall in patients with type 2 diabetes mellitus and ACS.

[Anxiety-depressive disorders in patients with type 2 diabetes mellitus complicated with acute coronary syndrome].

Psychological status of 140 patients with type 2 diabetes mellitus (DM) and acute coronary syndrome (ACS) was studied on the 12-th day after the moment of admission to the cardioreanimation department and in 6 months after discharge from hospital. Spielberger questionnaire was used for assessment of level of personal and reactive anxiety, Beck scale -- for estimation of level of depression, and Holmes - Ray scale -- for calculation of total number of stressful events. Average level of anxiety in acute period of ACS corresponded to high level of anxiety disorders (reactive anxiety score 47.64 +/- 10.49, personal anxiety score 48.7 +/- 8.77). Level of depressive disorders was in the limits of 3-49 points (median score 15.1 [5.1; 32.9]). Clinically evident depression corresponded to moderate and severe degree in 48.6% (68 of 140) patients. Mean total number of stressful events was 154 +/- 9.8 (median 129 [68.8; 317.8] points). After 6 months of follow up levels of personal and reactive anxiety remained high and were approximately equal to initial (45.63 +/- 11.3 and 40.79 +/- 11.6 points, respectively). Depressive disorders persisted in 57.4% of patients and level of depression corresponded to moderate and severe depressive disorders in 37.7% of cases. High prevalence of anxiety-depressive disorders was revealed in patients with type 2 DM complicated with development of ACS. Anxiety-depressive disorders persist minimally for 6 months after ACS.

[Neurologic analysis of cerebral exhaustion]. / Nevrologicheskii analiz tserebral'nogo istoshcheniia.

The study was aimed at determining the role of cerebral dysfunction in exhaustion syndrome involving various disorders of feeding motivation (anorexia, bulimia). Clinicopsychological study (neurological, endocrinological investigation, Cattell, Levine-Hoppe and MMIL testing) was performed in 23 women with exhaustion syndrome. The patients were divided into 2 groups: (1), 12 patients with bulimic neurogenic anorexia; (2), 11 neurotic patients with genuine anorexia. All patients displayed the background dysfunction of the cerebral integrative systems with motivational, neuro-metabolic-endocrine and autonomic disorders. Constitutional acquired hypothalamo-hypophyseal insufficiency had special traits in either group, a factor substantially influencing the course of the disease. The fact that neurogenic anorexia combined with hypothalamo-hypophyseal insufficiency was crucial for the establishment of bulimic form in particular, and for increased incidence of neuro-metabolic-endocrine disorders. Contrarily, the exhaustion syndrome in neuroses developing on the background of hypothalamo-hypophyseal insufficiency was influenced by the decompensation of initial motivational (anorexia) and neuro-metabolic (asthenic constitution) signs. It was also under the impact of specificity of symptom formation in neuroses with hypothalamohypophyseal disorders, including the feeding behavior pathology. The study implies the necessity of evaluation of the brain states with due consideration of cerebral factors in shaping neurogenic anorexia and neurosis.

[Pseudohypoparathyroidism. Clinical characteristics and experience with its treatment with vitamin D 3 preparations]. / Psevdogipoparatireoz. Klinicheskie osobennosti i opyt lecheniia preparatami vitamina D3.

The paper is concerned with the literature data on pathogenesis and a clinical course of 2 types of PHPT. Clinicolaboratory findings show that PHPT is a polymorphous syndrome of which the most common signs are skeletal changes, low stature, the tetanoid syndrome in hypocalcemia, hyperphosphatemia, the normal or raised level of endogenous PTH, insensitivity to exogenous PTH, soft tissue and brain calcification, mental deficiency. An insufficient or paradoxical PTH reaction and an adequate CT reaction are noted after calcium drug loading. Therapy with I alpha OH D3 and I alpha, 25/OH2 D3 has demonstrated its superiority over other vitamin D forms leading to fast normalization of calcium-phosphoric metabolism and elimination of the tetanoid syndrome.