No 3 (2010)

The Russian consensus on the treatment of children and adolescents with diabetes mellitus (DM) presents the modern requirements for compensation of DM in this category of patients - the most important and unique way for prevention of development of specific vascular complications, as well as ways to achieve compensation using modern methods of insulin therapy. The guidance manual contains information for the pharmacokinetics of modern forms of insulin, the schemes of their administration, the problems of insulin therapy and ways to their decision. Particular attention is paid to the most modern and effective treatments for diabetes - short-acting insulin analogues and insulin analogues with prolonged action, as well as insulin pumps. Developed Consensus is based on data from large international studies and international experience, as well as the results own research and experience of clinical practice taking into account the standards of the WHO experts at the Institute of pediatric endocrinology FSI ERC RMT, which concentrates the most complex contingent of diabetic patients from different regions of our country.

Cardiovascular complications are the main causes of mortality in patients with type 2 diabetes mellitus. Importance of accurate glycemic control aimed to prevention of these complications is proved. However, the use of some oral hypoglycemic agents, particularly sulfonylurea derivates (SUD), is accompanied by increase of cardiovascular risk, which can be explained by closure of ATP-dependent potassium channels. Whereas in the pancreas this mechanism leads to the stimulation of insulin secretion, it suppresses the phenomenon of ischemic preconditioning in the heart - an endogenous cardioprotective mechanism for prevention of fatal myocardium infarct. However, the effects of SUD on KATP channels in experimental studies are contradictory, and their clinical significance is not clear. Despite the structural differences in SUD and their varying ability to binding to the heart KATP channel receptor, to date there is no clinical evidences allowing to confirm the benefits of cardioprotective effect of any given SUD. This review is concerned with issues of molecular and cellular pharmacodynamics of SUD and data for their effects on the heart in patients with diabetes mellitus, with particular emphasis on glibenclamide - the most widely used SUD, which has the highest affinity for the KATP channel receptors in heart.

Modern data on the nature of osteoporosis (OP) are presented. Forms of osteoporosis associated with endocrine diseases (thyroid pathology, diabetes mellitus, Cushing's basophilism, hyperparathyroidism) are considered. It is emphasized that the endocrinologist in the clinical practice uses the whole arsenal of medicines for treatment and prophylaxis of OP, such as both hormonal and nonhormonal methods for therapy of primary and secondary forms of OP. We discuss the modern methods of pathogenetic therapy and prophylaxis of OP using bisphosphonates, strontium ranelate, active metabolite of vitamin D, and several other drugs. Administration of these drugs can effectively prevent bone fractures in the OP.

The article is dedicated to modern concepts of epidemiology, pathogenesis and clinical presentation of multiple endocrine neoplasia syndrome type 1 (MEN 1). MEN-1 is a rare congenital autosomal dominant syndrome caused by mutation of the MEN1 gene, localized on chromosome 11q13. Combination of tumors of parathyroid glands, pituitary and pancreas is typical for MEN-1. The algorithm for diagnosis of MEN-1syndrome is considered, the possibility of its treatment, including the use of somatostatin analogs is discussed. It is emphasized that in patients with various manifestations of MEN-1 syndrome due to accurate diagnosis and modern methods of surgical and medical treatment prognosis is significantly improved and life expectancy is increased in recent years.

We consider the modern potentials for use of selective somatostatin analogs in the treatment of acromegaly. The comparative data for the analogues widely used in clinical practice (preparations of octreotide and lanreotide) are presented. The results of clinical studies aimed to evaluation of effectiveness of selective analogue of somatostatin with prolonged action - Somatuline®Autogel® - in acromegaly are considered. Mechanisms of antisecretory and antiproliferative effects of the drug and the optimal scheme of its use are discussed.

The feasibility of the use of specialized products for enteral nutrition (EN) for the purpose of glycemic control and blood lipid profiles in patients with diabetes mellitus (DM) is well-founded. The authors performed comparative examination of the magnitude and duration of postprandial glucose (PPG) in 34 patients with type 2 diabetes mellitus (DM2) against the background of consumption of specialized product for the EP "Glucerna SR" and conventional food load. Evaluation of PPG and the areas under the glycemic curves in DM2 patients showed less postalimentary glycemic response as a result of "Glucerna SR" consumption. The findings suggest that specialized product for the EP "Glucerna SR" can be used in the diet of patients with DM2 as an additional source of energy and micronutrients.

The results of the study aimed to examination of efficacy and safety of drug Galvus (vildagliptin) in 1109 patients with type 2 diabetes mellitus (DM2) in the Russian clinical practice are presented. The findings showed that the use of the drug Galvus as monotherapy and in combination with metformin or sulfonylurea medications lead to significantly improvement of glycemic control in patients with DM2. This drug has no effect on body weight, can reduce body weight against the background of low-calorie diet and increasing physical activity. Vildagliptin is well tolerated, have no severe side effects and does not cause hypoglycemic state.

The main purposes of drug therapy of coronary heart disease are the reduction of myocardial oxygen demand or increase of oxygen delivery through vasodilation. Metabolic therapy is of greatest interest, because it can solve the problem of reduction of oxygen demand and significantly improve the efficiency of its utilization in myocardial ischemia. The study was aimed to evaluation of efficacy of prehospital use of cytoprotector Mexicor with subsequent intracoronary administration during first hours in patients with acute myocardial infarction (AMI). 82 patients with AMI admitted in hospital within 4 hours of onset were examined. According to the results, successful angioplasty of infarct-associated coronary artery and intracoronary administration of cardioprotector Mexicor leads to significantly improvement of clinical efficacy of the restoration of the coronary circulation and prevention of myocardial reperfusion injury.

The clinical significance of Stellwag's sign (rare blinking, exophthalmos) specific to hyperthyroidism is discussed. For the first time this symptom was described by the Austrian ophthalmologist Carl Stellwag von Karion. The symptom is especially important for those specialists (ophthalmologist, internist, cardiologist, neurologist), which initially may contact with patient suffering from hyperthyroidism.