[Consensus on the treatment of type 2 diabetes mellitus]. / Konsensus otnosno lechenieto na zakharen diabet-tip 2.

The outcome data from the United Kingdom Prospective Diabetes Study (UKPDS) showed that intensive drug treatment of diabetes mellitus-type 2 and the tight control of glycaemia and blood pressure are associated with lower incidence of chronic diabetic complications and mortality. The economical analysis showed out that money invested in the intensive drug treatment of diabetes and arterial hypertension resulted in less expenses for the treatment of diabetic complications. These data are the reason to suggest an algorythm for the treatment of diabetes mellitus type 2. The main aims are to achieve fasting blood glucose < or = 6 mmol/l, 2 hour postprandial glucose < or = 8 mmol/l and glycated haemoglobin (HbA1c) < or = 7.0%. The steps in the treatment include: non-pharmacological treatment, monotherapy with an oral drug, combined oral treatment, insulin therapy, combined insulin and an oral drug therapy. The blood pressure control aims to achieve a figure below 140/85 mm Hg, using monotherapy or a combination of antihypertensive drugs from different pharmacological groups.

[Basedow's disease in a female patient with breast cancer metastasizing to the thyroid]. / Bazedova bolest u bolna ot rak na gurdata, metastaziral v shtitovidnata zhleza.

A case is presented of a woman with a breast cancer who developed Basedow's disease several months after the diagnosis of the cancer. In spite of the antithyrotoxic treatment the Basedow's symptoms persisted till the end of life. The case is compared with other similar cases in which the combination of Basedow's disease with a metastatic tumour of the thyroid gland is not described. Probably the tumour invasion of the thyroid gland triggers the appearance of various clinical syndromes of hyperthyroidism including the full classical picture of Basedow's disease as is the case in the reported patient. The intimate etiopathogenetic mechanisms of these thyrotoxic syndromes are not yet clear.

Xeroradiography of the diabetic foot.

The authors carried out comparative xeroradiographic and radiologic examinations of 34 patients suffering from diabetes. It has been established that xeroradiography allows an earlier and more convincing diagnosis of arterial calcifications, indurations of small size arteries, phleboliths and fistulous tracts. In diabetic gangrene the initial lesions and bone sequestra are more clearly visualized, as well as the intra-articular bone fragments and parosteal calcifications in diabetic osteoarthropathy.

[Treatment of diabetic ketoacidosis by continuous venous infusion of small insulin doses]. / Lechenie na diabetnata ketoatsidoza s neprekusnata venozna infuziia na malki dozi insulin.

The authors treated 60 patients with diabetic ketoacidosis by continuous venous drop insulin infusion with 8 U every hour during the first six hours and after the sixth hour--20 U every three hours. Rehydration was performed with physiological serum in case of glycemia over 200 mg% and with 5% glucose serum in glycemia under 200 mg%. The patients were led out of ketoacidosis in approximately 9 hours and 36 minutes, the blood sugar diminution being slow and gradual, without hypoglycemic incidence. The average total insulin dose used was 72 U. The authors recommend that method for the practice with a view to its simplicity, safety and high effectiveness.

Plasma growth hormone level in the Morgagni-Stewart-Morel syndrome.

In 10 patients with Morgagni-Stewart-Morel syndrome the basal plasma growth hormone level was slightly increased. There was no decrease of plasma growth hormone after glucose loading in most of the patients. These findings were supported by the histological picture of the adenohypophysis of an accidentally died patient. A microadenomatosis of adenohypophysis consisting of acidophils or basophils was found. The increased growth hormone secretion might be responsible for the hyperostosis and some other features of the Morgagni-Stewart-Morel syndrome.