A total of 150 patients with carbohydrate metabolism disorders were examined: 58 with insulin-dependent diabetes mellitus (IDDM), 14 with impaired tolerance of easily assimilable carbohydrates, 67 subjects at risk of these conditions (sibs), 11 patients with non-insulin-dependent diabetes mellitus (NIDDM), and 50 donors. Autoantibodies to pancreatic islet cells (ISA) were tested by two methods: indirect immunofluorescence with cryosections of human pancreas and enzyme immunoassay with the Isletest kits (Biomerica). In IDDM patients with the disease duration of up to 2 years, ISA were detected in 66.7% cases on cryosections of human pancreas and in 50% cases by the Isletest. There was a general tendency to a lower rate of ISA detection with a longer duration of the disease. The results of the two methods did not agree. Autoantibodies to insulin (IAA) were detected in 37.5%) of these patients, which indicates the need in a comprehensive approach to immunodiagnosis of the preclinical stages of IDDM.

The mechanisms regulating post-meals glycemia were studied by evaluating the time course of glycemia and plasma levels of insulin, C peptide, and gastric inhibitory polypeptide (GIP) in 21 diabetics with type 2 condition after carbohydrate loading (50 g) with various sources of vegetable and animal protein (textured soybean product (TSP) and boiled meat (BM). The patients were distributed into 3 groups by random sampling. In group I and in the controls, standard carbohydrate test meals (wheat bread, 50 g carbohydrates) were used. In groups 2 and 3, wheat bread was supplemented with TSP and BM, respectively. All studies were carried out on an empty stomach and 60 and 120 min after test meals. Addition of BM and TSP to dosed carbohydrate meals promoted a lesser increment in the post-meals glycemia in diabetics with type 2 condition, which was associated with a significant increase in the levels of insulin and GIP after meals including BM and a tendency to their decrease after meals including TSP. The mechanisms of hypoglycemic effect of protein are discussed.

A total of 120 diabetics (39 men and 81 women) treated at regional clinical hospital of Archangelsk were examined in order to disclose the relationship between alcoholization and metabolism, visceral status in diabetes, and clinical course of diabetes in alcohol abusers. Fifty-eight examinees suffered from insulin-dependent and 62 from non-insulin-dependent diabetes mellitus. The results indicate that even low amounts of alcohol aggravate the course of diabetes, particularly the insulin-dependent condition; the disease in such patients is characterized by frequent hypoglycemic episodes, disposition to ketoacidosis, labile course, and hence, more frequent angiopathies. 8.3% examined diabetics presented with signs of chronic alcoholism. Diabetics with chronic alcoholism develop pronounced metabolic disorders, liver and pancreatic dysfunctions. One more cause of rapid progress of complications in patients abusing alcohol is social dysadaptation. Correction of behavioral alcoholic stereotypes and life style of diabetics is expected to play an important role in the system of therapeutic and prophylactic measures for this patient population.

Activities of department for suppurative infections are analyzed for 13 years. A total of 2099 diabetics with pyonecrotic complications were treated there, which made up 7.5%o of all inpatients. Of these, 1234 (58.8%) were hospitalized for pyonecrotic processes in the lower limbs. During 13 years, the number of diabetic inpatients increased by 36.6%, the number of operated patients with insulin-dependent diabetes (IDDM) increased 17 times, and of those with non-insulin-dependent condition (NIDDM) 8.72 times. Primary high amputations of the limbs were carried out in 4%o patients with IDDM and in 30.2% patients with NIDDM. Primary radical operations on the foot were performed in 96%o IDDM patients and in 69.8%o NIDDM ones. Two years after primary radical surgery, the limb was lost in 14.5%) of IDDM patients and in 34.2%o of NIDDM ones. The authors adhere to modern primary radical operations on the foot, followed by fitting with adequate prostheses, and emphasize poor organization of prehospital medical care.

In recent years, a significant increase in thyroid diseases, especially after the Chernobyl disaster, determines the increased interest of researchers in further studying the structure and function of this organ under normal and pathological conditions.

The autonomic balance has been evaluated by rhythmographic methods in 132 children aged 11-12 years living in a zone of moderate iodine insufficiency (Bishkek) with urinary iodine levels 35±7.7 mcg/liter and incidence of goiter 43.6%. By the results of ultrasonic examination, the examinees were divided into 3 groups: 1) with thyroid less than 6 cm³; 2) with thyroid of 6-10 cm³; and 3) with thyroid larger than 10 cm³. The tone of the sympathetic compartment of the autonomic nervous system was decreased in group 3 (relative vagotonus). The levels of iodine excretion, triiodothyronine, TTH, and hydrocortisone were virtually the same in all groups. The level of T4 was significantly decreased in group 3. Hence, the sensitivity of the negative feedback in the hypothalamo-pituitary-thyroid system is decreased in vagotonic children, and the thyroid in these children is more liable to hyperplasia under conditions of iodine deficiency.

Glucose, lipids, insulin, C-peptide, hydrocortisone, and thyroid hormones were measured in the indigenous population of Northern Siberia (Evenks) with normal (244 subjects) and excessive (108 subjects) body weight and with obesity (53 subjects). Obesity in indigenous Northerners was not associated with changes in the blood metabolic parameters. The levels of glucose, total lipids, triglycerides, and cholesterol did not essentially change with body weight increase. Body weight increase did not modify the activity of lipid metabolism, as was shown by stable ratio offree fatty acids to triglycerides during development of obesity. The levels of hydrocortisone and thyroid hormones did not depend on obesity. Excessive body weight in indigenous Northerners did not involve changes in the blood levels of insulin and C-peptide; a significant increase in the blood insulin level was observed only in obese subjects. The results indicate that development of obesity in indigenous population of the Northern Siberia does not manifest by obvious hormonal shifts and does not modify the lipid spectrum of the blood and level of glycemia.

The significance of circulating antibodies to adrenal steroidogenesis enzymes P450c21, P450cl7, and P450scc in the etiological diagnosis of primary chronic adrenal insufficiency (1-CAI) and autoimmune polyglandular syndromes (APS) was evaluated by immunoblotting with recombinant homologous enzymes. Sera from 54 patients were tested: from 6 patients with tuberculous 1-CAI, 23 with isolated autoimmune 1-CAI, 15 with 1-CAI within the framework of type 2 APS (APS-1), 6 with 1-CAI within the framework of type 1 APS (APS-1, candido-polyendocrine syndrome), 3 with A PS-2 without 1-CAI, and from 1 patient with autoimmune oophoritis. The above antibodies were not detected in patients with tuberculous 1-CAI and with APS-2 without 1-CAI, or in the patient with autoimmune oophoritis. Antibodies to P450c21 were detected in 17 out of 23 (74%)) patients with isolated autoimmune 1-CAI, 12 out of 15 (80%o) patients with APS-2, and in 5 out of 6 (83%) patients with APS-1. No antibodies to P450cl7 were detected in patients with isolated 1-CAI; these antibodies were detected in only 1 out of 15 (6.6%) patient with APS-2 and in 4 out of 6 (67%)) patients with APS-2. Antibodies to P450scc were detected in 4 out of 23 (17.4%o) patients with isolated 1-CAI, 1 patient with APS-2, and in 4 out of 6 (67%o) patients with APS-1. Analysis of the results for groups with autoimmune 1-CAI and APS-2 (38 patients) showed that in the subgroup with 1-CAI lasting less than 15 years antibodies to P450c21 were detected in 86.2+6.4% cases, while in patients with 1-CAI duration of 15years or longer they were detected in 44.4±16.56%o cases (t=2.35; p<0.05). Hence, testing of antibodies to P450c21 is a valuable instrument for the etiological diagnosis of 1-CAI, specifically, for the differential diagnosis of autoimmune and tuberculous 1-CAI.

Consensus. Endemic goiter in children: terminology, diagnosis, prevention and treatment

Ultrastructural studies confirmed the functional relationship between the nonparenchymatous cells of the liver and hepatocytes during blood glucocorticoid and lipoprotein metabolism. Lipopolysaccharide stimulation of macrophages induced a parallel decrease in the blood glucocorticoid concentration and share of HDLP3 and LDLP in the lipoprotein spectrum. In vitro experiments demonstrated that it involved a sharp increase in the capture and transcytosis of labeled lipoproteins (particularly HDLP3) through sinusoidal cells. Alteration of the hepatocyte nuclei is a morphological manifestation of the cooperative effect of glucocorticoids and HDLP3 and less so of the joint effect of glucocorticoids and LDLP. Stimulation of macrophages leads to an increase in the relative volume of the nucleoli in the nuclei and in the content of the granular substance in them, and in the compactness of porous complexes. These rearrangements are an obligatory condition for gene expression and intensification of protein production in hepatocytes.

A polyA-containing thyroglobulin mRNA (mRNAptf) was isolated from human thyroid in health and congenital goiter. A singlestranded complementary DNA (cDNA) was synthesized on a polyA-containing mRNA_Tl[ matrix by reverse transcription in the presence of RNAse inhibitor from human placenta; this cDNA was used in hybridization experiments for measurements of mRNA. The amount of mRNApH in the presence of TH deficiency was normal in the examined goiter case, indicating an impaired TH gene expression at the translation level.

In connection with the successes achieved in therapy, the number of patients with prolonged and persistent remission of oncological and hematological diseases is steadily increasing. The doctor faces the urgent task of maintaining the quality of their life, especially given the young age of the sick (for example, about 70% of patients develop lymphogranulomatosis from 16 to 45 years old). As you know, neoplasia and their treatment can potentially interfere with some cellular, anatomical or behavioral processes that determine normal sexual and reproductive functioning [16, 18, 25, 43, 45, 67]. Cytostatics and antimetabolites used in treatment programs for most hematological and oncological patients, in addition to the direct expected effect, have a deep and often long-lasting destructive effect on human gonads. Both endocrine and germinal functions can be damaged. Infertility, sexual disorders develop, symptoms of pathological menopause appear: increased blood pressure, dyspareunia, vegetovascular dysfunction, irritability, urogenital disorders and premature menopause. Against the background of hypoestrogenism in menopause, cardiovascular diseases, widespread osteoporosis, kraurosis and deep psychological trauma to the patient occur [2, 3, 5, 50, 54, 58].

Modern diagnostics and adequate treatment of various diseases of the adrenal glands are one of the most important problems of clinical endocrinology. Features of the topographic location of the adrenal glands, the possibility of extra-adrenal localization of tumors, a wide range of clinical manifestations, and sometimes their absence, often the small size of volume formations - all this makes the diagnosis of adrenal gland diseases far from an easy task [1,6, 13, 16, 17, 21, 26]. In the diagnostic algorithm, setting a topical diagnosis, identifying the nature and degree of morphological changes in the adrenal glands and possibly the most accurate assessment of their functional activity in order to determine the optimal treatment tactics and prognosis are important. In connection with the widespread introduction in clinical practice of modern highly informative research methods (polypositional ultrasound with color Doppler mapping, fine-needle aspiration biopsy under ultrasound control, standard computed tomography - CT, spiral CT, magnetic resonance imaging - MRI, etc.) angiographic methods of topical diagnosis faded into the background, and indications for their use somewhat narrowed [3, 23, 56]. However, in many diagnostically complex cases, the above non-invasive methods do not fully meet the requirements of surgeons in terms of clarifying the prevalence of tumor damage, organ affiliation, the degree of invasion of surrounding organs and anatomical structures. In addition, along with topical diagnosis in a number of patients, the evaluation of the functional activity of the affected adrenal gland is important [1-3, 13, 20, 80]. In this regard, the use of techniques based on determining the level of hormones and their metabolites in the blood flowing from the right and left adrenal glands is of undoubted interest, which makes it possible to objectively evaluate their functional activity [3, 20]. Therefore, first of all, it is necessary to determine the place of invasive angiological techniques in the modern algorithm for diagnosing adrenal diseases, which will qualitatively increase the level of differential diagnostic search.