[Insulin needs of insulin-dependent diabetics during biostator control and subcutaneous use of insulin]. / Insulinovi nuzhdi pri insulinozavisimi diabetitsi po vreme na biostatoren kontrol i podkozhno prilagane na insulin.

20 insulin-dependent diabetics, aged 17 to 52 years, duration of the diabetes from 1 to 22 years and mean value of the glycated hemoglobin 13.5 +/- 3.6% were studied. The 24 h insulin needs were determined with the help of an artificial pancreas (Biostator) at the following constants of the algorhithm: KR = 70, KF = 67, BI = 80, RI = 12, QI = 40, FI = 400, BD = 55, RD = 25, QD = 20, FD = 200 The insulin needs determined by the biostator were compared with those given subcutaneously which had, led to compensation of the diabetes before discharge of the patients. The mean insulin dose by the biostator was 1.0% U/kg and that of the subcutaneous insulin treatment was 0.86 U kg the difference is statistically insignificant). The above mentioned constants are recommended as being more physiological for the determination of 24-h insulin needs for a subcutaneous insulin treatment of diabetes.

[Treatment of obesity with a very low-energy dietetic regimen--the endocrine parallels]. / Lechenie na zatlustiavaneto s mnogo niskoenergien dietichen rezhim--endokrinni paraleli.

25 patients with various degree of obesity treated with a very low-caloric diet (Dresden diet) were followed up dynamically. By an average clinical stay of 22 days a satisfactory reduction of the body mass with mean 6.6 kg was achieved at mean reduction of the body mass index from 34 to 31. The blood sugar level, immunoreactive insulin in the course of the oral glucose tolerance test, the 24 h rhythm of the plasma cortisol and the aldosterone level at rest and in orthostatic position at the beginning and the end of the dietetic treatment were followed up. The results achieved are discussed in relation to the reduction of the body mass.

[Bilateral adrenal metastases with the clinical manifestations of hypocorticism in rectal cancer]. / Dvustranni nadbubrechni metastazi s klinichni proiavi na khipokortitsizum pri rak na rektuma.

Metastases in the suprarenal glands are being found in patients with neoplasms but symptomatic hypocorticism is described in single cases only. Computed tomography allows the diagnosis of suprarenal metastases causing hypocorticism while the patients are still alive. A case of a man, 40 years of age, with rectal carcinoma and clinically manifested hypocorticism due to bilateral suprarenal metastases is presented.

[A rare case of Itsenko-Cushing disease accompanied by gangrene of the fingers and cryoglobulinemia]. / Riaduk sluchai na bolest Itsenko--Kushing, suprovoden s gangrena na prustite i krioglobulinemiia.

A case of a woman with Itsenko [correction of Icenko]-Cushing's disease and a rare complication--necrosis of the fingers of the left hand--is presented. Besides the known factors of hypercorticism injuring the vascular wall, cryoglobulinemia was found in the patient. It is probably secondary in this disease and points out the complicated changes in the immunologic state of the patients with Itsenko [correction of Icenko]-Cushing's disease.

[Dynamic changes in the hemostatic indices of diabetics during biostator control]. / Dinamichni promeni na niakoi pokazateli na khemostazata pri diabetitsi po vreme na biostatoren kontrol.

In 25 patients with insulin-dependent diabetes and without microangiopathic complications the main hemostatic inhibitors antithrombin III, alpha-2-macroglobulin, and alpha-2-antiplasmin were examined before and after an optimal compensation of the carbohydrate metabolism was achieved. The patients were treated for 24 hours with the help of an artificial endocrine pancreas--biostator. The initial mean value of hyperglycemia of 15.61 mmol/l fell significantly to a mean value of 5.67 mmol/l at the end of the 24 hour treatment. During this 24 hour period the levels of the indices followed up did not change significantly. They were as follows: antithrombin III--98.48%, alpha-2-macroglobulin--112.25%, alpha-2-antiplasmin--110.68%. The lack of changes in the hemostatic inhibitors is explained by the short term biostator treatment.

[Metabolic ketoacidosis in obese subjects resulting from dietetic and exercise regimens to reduce excess body weight]. / Metabolitna ketoatsidoza pri litsa sus zatlustiavane vsledstvie redutsirasht svukhtelesnata masa dietichen i dvigatelen rezhim.

62 obese patients (44 women, and 18 men), mean age 43 years, were treated for one month in the rehabilitation center in Loznitsa by a hypocaloric diet and e physically active regimen. The average reduction of body mass was 11,248 +/- 3,392 kg. The treatment led to a marked ketosis--increase of pyruvate, acetacetate and beta-hydroxybutyrate, the increase of the most active metabolic component--beta-hydroxybutyrate being the greatest. The increased ratio beta-hydroxybutyrate/acetacetate could be considered favourable in relation to the energetic dysbalance since beta-hydroxybutyrate metabolizes faster than acetacetate. In patients with disturbed glucose tolerance, as well-as in patients with liver and renal diseases, gallstone disease, podagra and disturbed calcium-phosphorus metabolism the body mass reducing regimen should be carried out strictly individually and carefully in order to avoid the unfavourable effect of severe metabolic disturbances which could arise because of pronounced ketoacidosis.

[Effect of biostator control on levels of contra-insulin hormones]. / Efekt na biostatorniia kontrol Vurkhu nivoto na niakoi kontrainsularni khormoni.

A 24 hour biostator control was carried out on 30 patients with insulin dependent diabetes, mean age 34 years (16-61 years) and mean duration of the disease 7 years (1-33 years). All patients had normal body mass (+/- 10% according to Broka's formula). The plasma levels of glucagon, growth hormone, cortisol and C-peptide were determined at the beginning and at the end of the biostator control. With the decrease of glycemia (from 12.71 +/- 4.3 to 5.75 +/- 1.5 mmol/l, p less than 0.001) only the cortisol level fell reliably (p less than 0.001), the growth hormone and glucagon levels fell statistically insignificantly. There is no reliable correlation between the contra-insulin hormones studied and the glycemia level.

[The level of glycosylated hemoglobin in obese patients]. / Nivo na glikiraniia khemoglobin u bolni sus zatlustiavane.

The glycosylated hemoglobin level was examined in 37 obese patients without manifested diabetes mellitus. The level was in the reference ranges. The patients who had lowered carbohydrate tolerance showed a tendency toward a higher glycohemoglobin level. The reduction of body mass was accompanied by a decrease of glycohemoglobin.

[Study of the "dawn phenomenon" using an artificial endocrine pancreas]. / Prouchvaniia vurkhu "utrinniia fenomen" s pomoshtta na izkustven endokrin pankreas.

30 insulin-dependent, C-peptide negative diabetic patients were examined with the help of biostator. The mean age of the patients was 29 years, the mean duration of the diabetes was 7 years and the mean index of body mas was 22. For the period from 0 to 8 o'clock in the morning the blood sugar level and the speed of the insulin infusion in order to maintain euglycemic level were examined at 1/2 hour intervals. The mean blood sugar level for the period 5-8 o'clock (5.71 +/- 0.31 mmol/l) was reliably higher (p less than 0.05) than that for the period 0-5 o'clock (5.4 +/- 0.18 mmol/l). The speed of the insulin infusion for the period 5-8 o'clock (0.52 +/- 0.09 IU/kg/min) was also reliably higher (p less than 0.02) than that for the period 0-5 o'clock (0.4 +/- 0.06 IU/kg/min). These two indices were correlated with the somatotropic hormone and hydrocortisone levels at 2 and 8 o'clock. The possible pathogenetic mechanisms of this "morning phenomenon" in diabetes is discussed.

[Effect of the complex treatment conducted in the rehabilitation center in the city of Loznitsa on oral glucose tolerance and insulin secretion in patients with morbid obesity]. / Vliianie na kompleksnoto lechenie, provezhdano v rekhabilitatsionniia tsentur v gr. Loznitsa, vUrkhu oralniia gliukozen tolerans i insulinovata sekretsiia pri patsienti s visokostepenno zatlustiavane.

In the rehabilitation center Loznitsa the influence of the comprehensive treatment on the oral glucose tolerance test and insulin secretion was studied in patients with high-degree obesity. A flat blood sugar and insulin curve by oral glucose tolerance test was found without manifested hyperglycemia and hyperinsulinemia. One month treatment leads to a decrease of the basal insulinemia on the background of which the stimulating effect of glucose loading is more clearly expressed up to the 120th minute but without increase of the absolute values above the reference ranges.

[Immunoenzyme methods for determining thyroid hormones]. / Imunoenzimni metodi za opredeliane na tireoidni khormoni.

The analytical reliability of the immunoenzyme methods for determination of the thyroid hormones thyroxin, triiodothyronine, thyroid-binding globulin, thyrotropic hormone and the thyroid-binding capacity was examined by the peroxidase activity of the marker enzyme of "Specol-11" 28 healthy controls, 28 patients with subcompensated insulin-dependent diabetes with mean duration of 8.4 years and 11 patients with hypogonadism were examined. In the diabetic patients were found changes in their thyroid state characteristic for hypothyroidism--increased thyroxin and a decrease of the thyroid-stimulating hormone with a lowered level of the binding proteins. The patients with hypogonadism showed changes mainly in the binding proteins level, a decrease of the thyroid-binding capacity with 70%. The results reveal interrelations between the thyroid gland hormonal state and other hormonal disorders.

[Our experience in treating diabetes mellitus with the preparation Minidiab]. / Nashiiat opit pri lechenie na zakharniia diabet s preparata Minidiab.

55 patients with non-insulin-dependent diabetes mellitus were treated with the new oral drug Minidiab. In 58.2% of the patients the carbohydrate metabolism was influenced. No relation between the immunoreactive insulin increase and the effect of the treatment was found. An extrapancreatic action of the drug is suggested as its hypoglycemic activity.

[Serum enzymes in hypothyroidism]. / Serumni enzimi pri khipotireoidizum.

The following parameters were studied in 27 newly diagnosed and not treated patients with primary hypothyroidism: TTH, creatine kinase (CK) with MB isoenzyme, lactate dehydrogenase (LDH) with isoenzymes LDH1 and LDH5, aspartate aminotransferase (ASAT) and alanine aminotransferase (ALAT) before and after 20-day substitutive therapy. It has been established that the enzymes were increased in about 60% of the untreated patients, and the typical enzyme constellation for hypothyroidism consisted of CK with MB isoenzymes, ASAT and LDH1. The myocardial isoenzymes were normalized within the period of substitutive therapy. The enzymes were established to be elevated only in the patients that had increased CK. The follow up of the above enzyme constellation before and during the initial phases of the treatment of hypothyroidism could provide considerable possibilities of differential diagnosis with ischemic heart disease, often manifested during that period. The determination of CK in advance would be a screening determining the necessity of studies on the enzyme constellation.

[Non-enzymatically glycosylated low-density lipoproteins in diabetes mellitus]. / Neenzimno glikirani lipoproteini s niska plutnost pri zakharen diabet.

In 24 diabetic patients and 23 healthy persons the fatty metabolism was studied (cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol and glycosylated LD-lipoproteins). Iin diabetic patients the glycosylated low density lipoproteins travel from the cathode to the anode at a distance of 37-57 mm and in the control group they travel to a distance of 18-22 mm. In spite of the insignificant differences of cholesterol levels between the diabetics and the control and of the total cholesterol level being in normal ranges, the nonenzymatically glycosylated LD-lipoproteins are in greater quantity in the diabetics which is a predisposing factor for early atherosclerosis. The establishment of a correlation between the blood sugar level and that of the glycosylated LD-lipoproteins in diabetic patients could serve as a criterion for early atherosclerosis.

[Dynamics of blood glucose, serum insulin and lipids during the oral glucose tolerance test in hyperthyroidism]. / Dinamika na kruvna gliukoza, serumen insulin i lipidi v khoda na oralen gliukozotoleransen test pri khipertireoidizum.

Blood glucose, serum level of IRI, NEFA, total and HDL-cholesterol during oral loading with 100 g glucose were studied in 42 patients (37 females and 5 males), at an average age of 46,3, with various forms of hyperthyroidism. Diabetes mellitus was established in 3 patients, and in 10--reduced glucose tolerance. The basal insulinemia is increased in the patients with normal glucose tolerance (mean value 36,34 microU/ml), as compared with those with reduced tolerance (22,94 microU/ml). It manifested a moderate increase but slowed down reduction during the test. The insulin-glucose ratio, an indirect index for tissue insulin resistance, is four-fold increased as compared with the healthy. The total cholesterol and NEFA in the patients with normal and reduced glucose tolerance were with similar levels but during the test NEFA were more pronouncedly reduced in case of normal tolerance. The level of HDL-cholesterol in patients with reduced tolerance is lower (means +/- S = 0,77 +/- 0,42 mmol/l), though insignificantly, as compared with that of normal tolerance (1,03 +/- 0,4 mmol/l). The changes in triglycerides are but opposite: higher (2,21 +/- 0,67 mmol/l) with reduced and lower (1,74 +/- 1,46 mmol/l) in normal glucose tolerance. The differences in HDL-cholesterol and in triglycerides grow in the course of the test. The role of the altered lipid indices is discussed, particularly in reduced glucose tolerance, in the genesis of cardiac complications in hyperthyroidism.

[Case of primary hypogonadism in congenital dyskeratosis: Zinsser-Cole-Engmann syndrome]. / Sluchai na purvichen khipogonadisum pri kongenitalna diskeratoza--sindrom na Zinsser-Cole-Engmann.

A rare case is described with congenital dermatosis, leading to systemic lesions of epithelium of skin and mucose, combined with primary hypogonadism. A very low level of testosterone was established with high gonadotropic hormones and prolactin. Hypogonadism was established to be the result from systemic changes of skin, its accessory and epithelium of seminiferous tubules in testes.

[Use of the artificial endocrine pancreas in the clinic]. / Prilozhenie na izkustveniia endokrinen pankreas v klinikata.

Via the artificial endocrine pancreas--apparatus "BIOSTATOR" 100 patients were studied and treated, namely: 90 with diabetes mellitus, 7 with hyperinsulinism and 3 with obesity. The 24-h insulin needs of the diabetics with insulin-dependent and non-insulin dependent with secondary exhaustion type of diabetes, were determined. The following subcutaneous insulin dosage was determined, depending on the insulin amount spent during the 24-h biostator control. It was established that the necessary reduction of the intravenously administered insulin is 30% on the average with the passing over to subcutaneous regime. The indices of lipid metabolism were also studied as well as numerous hormones with which the carbohydrate compensation leads to a change. The problem of the "morning" phenomenon is discussed.

[Lipoatrophic diabetes with hypertrophic subaortic stenosis]. / Lipoatrofichen diabet s khipertrofichna subaortna stenoza.

A rare case is described of the combination of lipotrophic diabetes with hyperrophic subaortic stenosis in a young female. The authors announce the good results from the administration of bromorgocryptin for the reduction of the considerable hyperlipoproteinemia in the patient. The scare experiences in literature from the administration of the preparation is emphasized as well as the difficulties in the explanation of its mechanisms of action, at the present stage of our knowledge.

[Informative significance of hemoglobin A1 in the control of diabetes]. / Informativna stoinost na khemoglobin A1 pri provezhdane na diabetniia kontrol.

Sixty one patients were studied, 23 with diabetes, type I and 38 with type II. The level of glycosilized hemoglobin was determined in all, corresponding to the routine battery of symptoms and laboratory data, used in the practice in the evaluation of the state of the diabetic patients. A low correlation coefficient was established (type I r = 0,1 and type II r = 0,1) between the calculated glucose and mean blood sugar from blood sugar profiles. Glycohemoglobin level under and over 10% was established both in patients with increased and normal blood sugar. The use of the routine control methods gave no possibility of objective evaluation for the state of metabolic diabetic disorders in all patients. The determination of glycosilized hemoglobin presented a possibility of obtaining unique information on metabolic compensation of diabetes and the effectiveness of the treatment applied.