Topical diagnostics of pathology of parathyroid glands (PTG) is an important stage of preoperative examination of the patients presenting with primary hyperparathyroidism (PHPT). Individual patients do not necessarily need the entire scope of the currently available diagnostic techniques to be applied for the elucidation of their clinical conditions. The objective of the present study was to estimate the diagnostic value of each concrete method and its combination with other tools. The data obtained point out to the high efficacy and specificity of each method of preoperative topical diagnostics of PTG pathology in the patients with PHPT. The sensitivity of ultrasound studies, scntiography, their combination, and multispiral computed tomography (MSCT) was estimated at 96.8%, 91.8%, 99.2%, and 95.2% respectively. Their specificity was 91.9%, 84.2%, 94.1%, and 94.1%. The study did not reveal a significant difference between sensitivity and specificity of ultrasound studies and the "golden standard" of diagnostics of PTG pathology. This finding allows the ultrasound studies to be recommended as the sole method for primary topical diagnostics of PTG pathology in the patients presenting with PHPT. At the same time, any doubt as regards the results of an ultrasound study requires that a more comprehensive examination of the patients be performed with use of the entire scope of the scintigraphic techniques including single-photon emission computed tomography (SPECT) and MSCT especially in the cases of atypical localization of parathyroid glands. The results of the study provided a basis for the development of the optimal algorithm for diagnostics of PHPT.

To estimate the prevalence of diabetes mellitus (DM) among the patients with acromegaly residing in the Moscow region (MR). A total of 93 patients aged from 48.0 to 64.5 (mean 57.5) years presenting with acromegaly from 7.5 to 20.25 (mean 13.0) years in duration were available for the examination. Twenty seven of these patients developed diabetes mellitus prior to acromegaly. Oral glucose tolerance test (OGTT) for diagnostics of DM was performed in 66 patients. The overall prevalence of diabetes mellitus among the patients with acromegaly was estimated at 51.6% which is higher than that in the general population of the Moscow region and worldwide (2.3% and 8.3% respectively). The prevalence of DM among women was higher than in men (55.1% and 33.5% respectively; p<0.05). It increased with age (from 14.3% in the patients aged between 36 and 45 years to 48.3% at the age above 56 years) and with duration of acromegaly (from 40.6% in the patients with the duration of the disease up to 8 years to 60.5% in those with acromegaly during more than 15 years; p<0.05). Asymptomatic diabetes was diagnosed in 34.8% of the 69 patients which is also higher than the prevalence of asymptomatic type 2 diabetes mellitus in a random sample from the adult population of MR and in the group with the enhanced risk of DM2. The prevalence of DM among the patients in the controllable and uncontrolled phases of acromegaly was 57.1% and 49.2% respectively (p>0.05). The prevalence of DM2 among the patients with acromegaly is significantly higher than in the world's general population; it depends on the patients' age and sex and as well as on the duration of acromegaly.

Specific features of colonic microbiocenosis were investigated in 64 patients presenting with osteoarthritis. They were divided into 4 groups including patients with the normal body weights and those with grade I, II, and III obesity respectively. The qualitative and quantitative analysis of intestinal microflora was performed by the bacteriological method. It was shown that obesity was associated with an increased frequency of isolation of enterococci despite their decreased content. Simultaneously, variations in the diversity of opportunistic microorganisms were documented. Alterations in the qualitative and quantitative composition of intestinal microbiocenosis in the patients with osteoarthrosis depended on the degree of obesity. Grade III obesity was associated with the most pronounced decrease in the occurrence of bacteroids, entercococci, and lactose-positive coliform bacteria. It is concluded that the development of dysbiosis in the large intestine should be taken into consideration in the choice of combined therapeutic strategy for the treatment of the patients with osteoarthritis and concomitant obesity of different severity.

Biliopancreatic diversion (BPD) surgery is one of the most efficacious bariatric procedures employed to manage morbid obesity. However, apart from a stable reduction of the body weight and beneficial action on the clinical course of various diseases associated with obesity, this method creates the risk of inducing osteometabolic disorders following the surgical intervention. We present here a clinical case of osteomalacia that developed in the late post-BPD period in the absence of regular intake of medicines and adequate medical care.

Carney complex is a rare hereditary syndrome characterized by an autosomal-dominant mode of inheritance and associated with multiple neoplasias affecting endocrine organs. The typical manifestations of this syndrome include pigmented micronodular adrenal dysplasia, lentiginosis, heart and skin myxomas, giant cell sertoliomas, and some other neoplasias. To date, a few hundred patients with this pathology have been described worldwide. A review of the available data about Carney complex is presented.

This paper highlights the main causes leading the development of insulin resistance (IR), its mechanisms, and the role it plays in living activity. The analysis of the available literature gives reason to believe that the source of IR is the constant requirement for plastic and high-energy compounds to be mobilized from the body's internal reserves. The mechanisms underlying the development IR involve all organ systems that interact between themselves and thereby govern the origin and evolution of insulin resistance via regulation of the energy generation and consumption processes. This concept is in excellent agreement with the laws of thermodynamics. The vital activity is based on the principle of continuous variations of IR. This inference provides a basis for addressing a number of clinical problems.

Melatonin secreted by the epiphysis and synthesized in adipocytes of the gastrointestinal tract participates in the regulation of carbohydrate metabolism by modulating activities of alpha- and beta cell of Langerhans islets in the pancreas; melatonin acts via its specific receptors (MT1 and MT2). Reciprocal interactions between melatonin and insulin have been demonstrated while melatonin deficiency is known to be one of the factors predisposing to the development of diabetes mellitus. It was shown that melatonin provides protection against diabetes through a variety of intracellular and systemic mechanisms.

The patients presenting with type 2 diabetes mellitus (DM2) not infrequently have concomitant diseases of the cardiovascular, respiratory, digestive, and urogenital systems which hampers the choice of optimal hypoglycemic therapy. The prescription of insulin injections appears to be the most natural and efficacious modality of such therapy. However, excessive doses of insulin are known to cause hypoglycemia and body weight increment. Hypoglycemia interferes with the optimal control of the diabetic patients' conditions especially in those of advanced age who may poorly respond to the treatment. In the present study, the intake of vildagliptin in combination with insulin administration resulted in the significant improvement of the characteristics of carbohydrate and lipid metabolism in the absence of overweight, with the minimal risk of hypoglycemia and cardiovascular diseases (complications).

The data on the efficacy of using ultra-short acting insulin preparations in insulin pumps for children and adolescents presenting with diabetes mellitus. Insulin pump therapy in the patients of these age groups is finding an increasingly wider application as being more convenient for the users and leading to the improvement of glycemic control. One of the main advantages of modern insulin pump therapy is the possibility to maximally imitate the physiological profile of insulin secretion. The flexibility of both basal and bolus dosing regimens of insulin administration can be further increased by using ultra-short acting insulin preparations in insulin pumps. The choice of any of the three currently available analogs of ultra-short acting insulin guarantees their identical efficacy and safety in the children and adolescents with type 1 diabetes mellitus. They can be recommended as insulins of choice for the use in pump therapy

This paper reports the results of the treatment of 71 patients presenting with type 2 diabetes mellitus using liraglutide, a long-acting analog of glucagon-like peptide-1 (GLP-1) marketed under the brand name Victoza. Practically all the patients experienced either improvement or normalization of the parameters of carbohydrate metabolism in conjunction with a reduction of their body weight and arterial pressure. There were no severe hypoglycemic episodes and other adverse reactions to the therapy. It is recommended that Victoza should be more widely used for the treatment of the patients with type 2 diabetes mellitus.

The onset of insulin therapy is an important stage in the treatment of type 2 diabetes mellitus. Its timely beginning ensures better control of glycemia and reduces the negative consequences of chronic glucose cytotoxicity and lipotoxicity. The achievement and maintenance of the stable compensation of the disease are the indispensable conditions for successful prophylaxis and adequate treatment of chronic complications of diabetes mellitus. The ADA guidelines recommend to initiate insulin therapy at the early stages of the disease provided it is dictated by the clinical situation or combine it with the use of oral hypoglycemic agents if the targeted HbA1c levels fail to be reached despite the intake of one or more tableted preparations.

According to the International Diabetes Federation, there are over 366 mln subjects suffering diabetes mellitus (DM) in the world. This figure is expected to reach 552 mln by 2030. The patients are treated with preparations acting on different components of DM pathogenesis on the one hand and with medicines facilitating prophylaxis of the disease on the other hand. Diabeton MB decreases the mean HbA1c level of 7-8% by 0.9%. Also, it causes reduction of the initial HbA1c levels of 8-9% and 10% by 1.7% (2.6---??) and 4.2% respectively. Diabeton MB produces a number of other effects besides the hypoglycemic activity; specifically, it reduces the intensity of LDLP oxydation, platelet adhesion and aggregation, adhesion of monocytes, etc.

Well-timed, effective, and safe therapy of type 2 diabetes mellitus (DM2) is a challenging problem for public healthcare systems all over the world. Glibenclamide is currently the most popular sulfanylurea derivative prescribed to the patients presenting with DM2. High requirements to the safety profile of modern medications including oral hypoglycemic agents imply the necessity of close attention to the potential problems associated with the long-term application of glibennclamide. The present review is focused on the topical problems of safety and efficacy of glibenclamide arising from its use in the clinical practice.

The advent of the new insulin pump with the function of automatic stopping delivery of insulin in response to hypoglycemia marks a new stage in the development of closed-loop devices for insulin administration. This review is devoted to insulin pump therapy with the use of this function. The results obtained up to now with the use of this technology with special reference to its efficacy and safety are presented.