Activities of 3 lysosomal enzymes in blood serum and leukocytes were studied in 115 with type 1 diabetes with and without vascular complications, different glycaemic and lipid peroxidation (LPO) status. Serum activities of N-acetylglucosaminidase and p-galactosidase were increased by 1.7 times and of acid RNAse by 1.6 times in patients with decompensated diabetes vs. the control. Shifts in enzymatic activities did not disappear with compensation of disease. Increased activities of lysosomal enzymes were observed in the patients with first diagnosed diabetes mellitus. The highest levels were observed in patients with pronounced vascular complications. Deficient activities of N-acetylglucosaminidase and p-galactosidase were detected in the blood leukocytes of these patients. Correlations between changes in the serum and leukocyte activities of lysosomal enzymes and accumulation of lipid peroxides (dienic conjugates and malonic dialdehyde) in erythrocyte membranes were disclosed. These data indicate alteration of the cellular lysosomal system in diabetics, contribution of LPO reactions to these shifts, and their relationships with development of microangiopathies.

Changes in the levels of circulating immunoglobulins and production of autoantibodies to basal membrane of renal glomeruli were studied in patients with insulin-dependent diabetes mellitus (IDDM) at various stages of diabetic nephropathy (DN). The number of patients with positive reaction to autoantibodies to renal basal membrane (R.BM) increases as clinical symptoms of DN augment. The greater part of patients with positive reaction to antibodies have stage 111-IV DN. Measurements of serum immunoglobulin concentrations in patients with DN of different degree showed maximal levels of IgG in initial IDDM (without DN); later IgG level gradually decreases, while IgM level shows a tendency to increase, this increase attaining statistically significant values in patients with pronounced nephropathy. In patients with antibodies to R.BM the ratios of IgG/IgD and IgM/IgD concentrations are elevated, while IgA/IgG and IgA/IgM ratios are lowered; only the IgG/IgD and IgA/IgG ratios differed significantly from the control. 26.8% patients with IDDM had antibodies to basal membrane of renal glomeruli. The number of patients with positive reaction to these antibodies increases with the progress of nephropathy, which can be indicative of the involvement of autoimmune mechanisms in development and progress of DN.

System of neonatal screening diagnosis (SD) of congenital diseases implies free-of-charge examinations of newborns, which is very expensive for the state. This is the cause for regular evaluation of the system’s efficiency. The evaluation includes analysis of clinical efficiency (detection rate and terms of treatment beginning) and economic efficiency (financial estimation of the ratio of prevented harm to financial loss). We evaluated medical efficiency of system of overall SD of congenital hypothyrosis (CH) in children born in Moscow in 1990-1998 (n = 601602) in order to develop recommendations on optimization of the system. The main efficiency criteria in recent years are as follows: 93-99% newborns were examined at the first stage of screening at maternity hospitals (vs. international standard > 95%); 88% subjects with abnormal results at the first stage were retested at the second stage (vs. international standard 100%); 3) babies ’ ages by retesting was 36 days, by the moment of diagnosis 55 days, and by the beginning of treatment 64 days (vs. international standard up to 30 days). Still, comparison of the results of SD with the data of the "prescreening epoque" (before 1990) demonstrates obvious positive shifts. Before SD was introduced in Moscow, CH was diagnosed in 67.5 ± 4.2%> children (2/3 of 123 cases) at even later terms, after 3 months of life; in 9 years SD value decreased more than 3-fold (p < 0.001) and the diagnosis was recorded in only 19.7 ± 4.6$ patients (1/5 of 76 cases). The detected errors and defects in organization and implementation lay the basis for recommendations on optimizing SD system in order to accelerate the process of CH detection and prescription of urgent therapy: 1) To improve the collection of information aimed at search of the child by modifying the initial blank in maternity hospital (to record home address and telephone number). 2) If the values of thyrotropic hormone at the first stage suggest CH (>50 IU/Hter), the diagnosis should be verified serologically at once, without the stage of whole blood retesting, which is performed only for values 20—50 IU/liter.

Ninety patients (61 women and 29 men) aged 18—60 years with primary hyperparathyrosis (PH PT) of several months to 12 years standing were observed. Control group consisted of 20 normal subjects (15 women, 5 men) aged 18—60 years. Osseous PHPT was diagnosed in 51 patients: mild in 6, moderate in 30, and severe in 15 patients. Mixed PHPT 33 was diagnosed in 39 patients (mild in 8, moderate in 23, and severe in 8). Six types of interventions were used. Solitary adenoma was found in 44patients (48.8%), paired and multiple adenoma of the thyroid in 33 (36.6%), thyroid hyperplasia in 10 (11.1%), and carcinoma in 3 (3.3%) cases. Surgical treatment promoted recovery and restoration of working capacity in 74.4% patients during the first 6 months and in up to 92.3% during the next 3—6 months after reoperation for relapses and hypoparathyrosis.

Prophylactic check-ups of 6950 adolescents aged 12—18 years and examinations of260 patients with pubertal juvenile dyspituitarism (PJD) were carried out in the Ural region. The incidence of PJD in the Urals has appreciably increased in recent years and now amounts to 96 patients per 1000 adolescents. The incidence of thyroid enlargement in PJD patients is 77.27% vs. 52.8% in the rest adolescents of the city of Perm. Clinical signs of hypothyrosis are observed in patients with PJD. Basal levels of ТТН, T3, T4, and prolactin were normal in the overwhelming majority of PJD patients, but loading tests with thyrotropin-releasing hormone and metoclopramide showed decreased thyroid function caused by hypothalamic involvement and primary thyroid impairment. The regulation of pituitary prolactin-producing function is impaired at the hypothalamic level in PJD patients (dopaminergic control of prolactin secretion is decreased). Psychological dysadaptation to disease is forming in the patients. The need in substitute therapy with thyroid hormones and in psychological correction supplementing pathogenetic therapy for PJD is obvious.

This paper reports the findings of search for probable hormone markers needed for diagnosis and choice of treatment strategy for patients with adrenal tumors without characteristic endocrine symptoms. Thirty women and 11 men with hormonally inactive tumors (HIT) and a control group matched for age and sex were examined. Steroid hormones were radioimmunoassayed. Tumor sizes varied from 1.3 to 10 cm according to ultrasonic examination, computer tomography, and results of surgery. The concentrations of the main steroid hormones and their precursors were virtually the same in patients with light-cell adenoma, HIT without morphological diagnosis, and controls. Some patients had high levels of corticosterone, dehydroepiandrosterone (DHEA) and dehydroepiandrosterone sulfonate (DHEA-S), which indicates the presence of adrenal hormonally-active tumors which were not diagnosed by standard hormone analysis including measurements of hydrocortisone and aldosterone. These data necessitate addition of measurements of corticosterone, DHEA, and DHEA-S in the protocol of examination of patients with HIT.

The aim of this study was to compare the efficiency of various methods of treating patients with abdominal obesity and dyslipidemia at the stage ofpreclinical manifestation of cardiovascular complications. One group (13 pts) was treated by diets, the other (19 pts) by diet and metmorphine in a daily dose of 1000 mg. The duration of study was 6 months. Anthropometric, biochemical, and hormonal values were checked up in all patients at the beginning and end of therapy and in some patients after 3 months of treatment. The results indicate that metmorphine in combination with traditional therapy is a rational treatment affecting various factors determining the summary risk of cardiovascular diseases in patients with abdominal obesity.

The most serious complications of diabetes mellitus, which are a frequent cause of disability and mortality in patients, include lesions of the lower extremities. Diabetic foot syndrome is a complex of its anatomical and physiological changes that develops as a complication of diabetes and is due to diabetic neuropathy, angiopathy, osteoarthropathy and the occurrence of purulent-necrotic processes. This syndrome complicates the course of diabetes in almost 25% of patients. The risk of lower extremity gangrene in these patients is 20 times higher, and their amputation is performed 15–40 times more often than in the general population [5].

The role of sex hormones in the mechanisms of pituitary adenoma development has been investigated. The concentrations of estradiol and testosterone nuclear receptors were evaluated in adenohypophyseal tumors of different structure: prolactinomas, meningiomas, somatotropinomas, astrocytomas, neurinomas, and ependymomas. The concentrations of estrogen and androgen receptors are much higher in prolactin-secreting pituitary tumors than in somatotropinomas and other pituitary tumors examined.

Main parameters of complex formation of corticosteroid-binding globulin (CSG) were studied in young male and female rats with hypothyrosis induced by mercasolyl in a daily dose of 6 and 30 mg/kg. No pronounced differences in CSG, typical of adult animals, were observed in young rats under conditions of thyroid function inhibition. Steroidand androgen-inhibitory and estrogen-inducing effects of hormones towards CSG did not manifest in hypothyrosis. Decrease in the level of thyroid hormones is characterized by increased affinity of CSG for glucocorticoids and a decrease in the concentration of binding sites. These data indicate that thyroid hormones are the primary regulators of CSG activity. Possibility of modifying CSG affinity and role of this factor in regulation of biological activity of glucocorticoids are discussed.

The problem of vitamins and diabetes has been the subject of a large number of experimental and clinical studies. They consider such aspects as the effect of insufficiency of certain vitamins on the induction (by alloxan or streptozotocin) of experimental diabetes mellitus; study of the protective effect of vitamins from these chemical agents; study of the actual provision of vitamins for people with diabetes; identification of the features of the metabolism of vitamins in this disease; the use of vitamins in prophylactic or therapeutic doses in the complex treatment of diabetes mellitus [20, 26, 51]. Despite the abundance of such studies, there is still no consensus on whether the exchange of B vitamins changes in diabetes mellitus. This is determined by a number of reasons, due to both the features of methodological approaches and the use of nonspecific analytical methods, as well as the application of the criteria for assessing vitamin supply, adopted for healthy people.

Sagadulla Abdullatipovich Abusuev (on the occasion of his 60th birthday)