[The effect of estrogens and progestagens on biochemical components of hemostasis, platelets, continuous intravascular coagulation and tolerance to thrombin: correction of their effect of antioxidants].

Estrogen and progestin (ethinylestradiol and levonorgestrel, respectively) accelerate LPO in platelets, activate them, increase continuous intravascular coagulation and reduce tolerance to thrombin. Antioxidants limit these effects.

[Diabetes mellitus and obesity: projection onto oncological morbidity].

Peculiar features of human morbidity and their changes in time are registered chronologically starting from the XVII-VYIIIth centuries. After the period of predominantly infectious diseases, chronic and non-communicable conditions continued to gain momentum in the last 3-5 decades. Side by side with AIDS, accidents, effects of smoking etc, the global epidemics of diabetes mellitus and obesity comes up to take a leading place in the general population morbidity. In this communication, possible causes of this situation and its possible association with cancer are considered based on the results of original studies. Measures for the prevention and treatment of these diseases are discussed.

[Evaluation of the rate of lipid peroxidation and antioxidant defense in blood during gynecological laparoscopic operations].

The impact of gynecological operations on the rate of lipid peroxidation (LPO) and erythrocytic antioxidant defense (EAOD) was studied in women with uterine myoma. The higher rate of LPO and the decreased level of vitamin E were preoperatively found. A further increase in LPO activity and a reduction in vitamin E concentrations were observed 1-4 days after surgery. Recovery of the study parameters was seen on days 5-7 postoperatively. The enzyme glutathione-S-transferase was ascertained to play a pivotal role in the EAOD system.

[Registry-based analysis of cancer and diabetes combination: prevalence and features].

Neoplasia was established in 5.4% out of 15,813 patients with diabetes mellitus registered at the City Population-Based Cancer Register and Territorial Diabetic Center, St. Petersburg. Gender-unrelated decreasing order of tumor sites was as follows: breast, skin, uterus, colon and stomach. Broncho-pulmonary and gastric cancer incidence in male patients with diabetes was higher than in females (3.5 and 2.2 times, respectively). The relationship was reversed with thyroid cancer and skin melanoma (4.4 and 2.3 times, respectively). In patients with type 1 diabetes mellitus (10.3%), the cancer incidence pattern differed significantly from that in the whole diabetes-associated cohort of cancer patients: the former tended to involve such sites as pancreas, urinary bladder, stomach, cervix uteri, lung and skin. Data on age at diagnosis of cancer or diabetes, insulin therapy intensity and body mass were evaluated. The value of timely screening for both cancer and diabetes mellitus in such cohorts was confirmed.

[Predictors of alpha-lipoic acid treatment efficacy in diabetic polyneuropathy of the lower limbs].

AIM: To study efficacy of sensory deficiency treatment with alpha-lipoic acid (ALA). MATERIAL AND METHODS: Twenty seven patients with diabetes mellitus (DM) type 1 and diabetic polyneuropathy of the lower limbs received ALA treatment (600 mg, i.v., drip, for 15 days followed by 600 mg, per os, for 2 months). Mean age 40.9 +/- 6.9 years, DM history 17.6 +/- 5.1 years, HbA1c--9.44 +/- 1.94% (standard 4.0-6.2%). Tactile, vibration, pain sensitivity was assessed, electroneurography (n. suralis, n. tibialis) was made. The severity of sensory deficiency was determined by 10-score Young scale. RESULTS: There were positive changes in objective and electrophysiological parameters. The severity of sensory deficiency and treatment effect depend on DM duration and initial sensory deficiency (predictory value of the regression model was 92%, p = 0.001), initial neuropathy severity was responsible for up to 66% of the effect. The highest positive response of polyneuropathy was achieved in initial threshold of vibration sensitivity under 16 V or in total score of neuropathy severity under 6. CONCLUSION: ALA treatment of sensory deficiency was most effective in patients with a short history of DM and mild initial neurological disorders (neuropathy severity by M. Young scale under 6 scores, threshold of vibration sensitivity under 16 V).

[A program for screening patients at a high risk for lower extremity ulcers and amputations].

A screening of patients with diabetes mellitus (DM) at a high risk for trophic foot ulcers and amputation has been made in Saint Petersburg since 2001. This study was undertaken to analyze the results of this screening. A total of 3807 patients with DM (96% with type 2 and 4% with type 1) were examined. The history of DM was 9.6 ±8.1 years; the body mass index, 30.4±8.2 kg/m2; mean age, 66.5±10.9 years. Passport data, the year of detection of DM, its type, anthropometric indices, history data on ulcerative defect of the foot and/or amputation were recorded. Arterial pulsation in both feet, sensitivity to 10-g monofilament; the presence of foot or toe deformities were assessed. The risk was determined in accordance with the modified recommendations of the International Agreement on the Diabetic Foot. Low, intermediate, and high, and very high risks were detected in 43.1, 37.3, 14.6%, and 5% of the examinees, respectively. The groups did not differ in age, but the patients at a very high risk had a long history of DM as compared with those at a low risk (14.9 ±9.1 versus 8.4 ± 7.7years; p <0.05). Foot deformity, severe polyneuropathy, lower extremity angiopathy were identified in 46, 11.5, and 10.6% of the patients, respectively. Foot and toe deformities were more frequently detected in type 1 DM. The substantially long persistence of DM was a cause of the high incidence of polyneuropathy, angiopathy, and a history of pyonecrotic processes in patients with type 1 DM. The proportion of patients at high and very high risks was almost 20%, which indicates that Diabetic Foot rooms should be set up. In the examinees, foot and toe deformities are the most common risk factors, which is largely due to the age of the population. The results of screening suggest that it is necessary to set up additional Diabetic Foot rooms, their work being aimed at foot care, and, in terms of the great spread of food deformity, to review the orthopedic provision system for diabetic patients.

[A trial of the use of the low-molecular heparin sulodexide in the therapy of diabetic nephropathy]. / Opyt primeneniia nizkomolekuliarnogo geparina sulodeksina v terapii diabeticheskoi nefropatii.

AIM: Investigation of sulodexide effects on renal function, hemostasis and lipid metabolism in patients with diabetes mellitus. MATERIALS AND METHODS: 20 diabetics (diabetes mellitus type I and II) received sulodexide (Vessel due F) for 3 weeks. This mixture of low molecular heparin and dermatan sylphate was injected i.m. once a day for 5 days a week with a 2-day interval. Micro- and macro-albuminuria diminished after treatment but further returned to baseline levels. The rate of glomerular filtration, blood levels of glucose and cholesterol, hemostatic parameters remained unchanged. Blood triglycerides fell. CONCLUSION: Sulodexide may be useful in pathogenetic treatment of diabetic nephropathy.

[Formation of small fields using tele-gamma therapy devices]. / Formirovanie malykh polei na distantsionnykh gamma-terapevticheskikh apparatakh.

Radiotherapy of certain tumor sites requires small-size fields of irradiation (less than or equal to 4 cm) with a good dose plateau and a sharp dose gradient on the field border. For this purpose a kit of accessories to beta-beam units includes a device with disposable collimators forming round fields with 20, 30 and 40 mm diameters, an oblong field 20 X 30 mm and segmental fields with axes 20 X 26 and 26 X 32 mm at a distance of 75 cm from a source. Dosimetric characterization of collimators was studied; dose fields formed by open beams using collimators were compared.

[Dosimetric characteristics of the C-4 grid diaphragm from a kit of shaping fittings]. / Dozimetricheskie kharakteristiki reshetchatoi diafragmy C-4 iz komplekta formiruiushchikh prinadlezhnostei.

A kit of equipment is manufactured at present for gamma-beam therapeutic units. The authors describe the design and geometrical parameters of a new grid diaphragm C-4 included in this kit. Characteristics of a dose field, formed by this grid, have been studied and are presented in this paper. Particular attention during the calculation of the dose time of an irradiation session under the opening should be drawn to an error in beam alignment.

[Use of shielding blocks for field formation in gamma teletherapy]. / Ispol'zovanie zashchitnykh blokov dlia formirovaniia polei pri distantsionnoi gamma-terapii.

Based on experimentally obtained dose distributions for irregular fields formed on the Rokus-M apparatus by means of shield blocks, a formula for the manual calculation of a dose rate in the open part of an irregular field was proposed. The formula makes use of the tissue air ratio and takes into account change of an equivalent field area in case of the use of central, shifted and edge blocks or their combinations.

[Conventional roentgenologic methods and computerized tomography in the preirradiation planning for patients with esophageal cancer]. / Konventsional'nye rentgenologicheskie metody i komp'iuternaia tomografiia v predluchevoi podgotovke bol'nykh rakom pishchevoda.

During the planning of irradiation of patients with esophageal cancer significant divergence is frequently noted between topometric maps obtained by conventional x-ray methods including axial tomography, and computerized tomography. Topometric maps based on these two methods were compared. Using a typical example of a series of 12 patients, divergences in expected dose loads on critical points were analysed on the basis of 3 variants of superposed topometric maps. Divergences in topometric maps result from errors in topometric methods and from an impossibility to reproduce precisely the level of a section and physiological conditions during repeated layings of a patient. Divergences in a focal dose (on the esophagus) can reach 8% in rotation radiotherapy, 20% in static irradiation, and on the vertebral canal 28 and 13% respectively. Factors that influence such divergences are discussed.

[Dosage fields of the "ANET-B" apparatus with 252Cf]. / Doznye polia apparata "ANET-B" s 252Cf.

The paper is concerned with the results of the calculation of dose fields of neutron and gamma-radiation for an ANET-B unit. Experimental measurements were done in the tissue equivalent phantom by using photoluminescent and alumophosphate glasses, thermoluminescent and threshold detectors with neptunium foil. Divergences between calculated and all experimental data did not exceed 10-12%. It has been shown that the ratio of the contribution of neutron and gamma-components of 252Cf radiation for the ANET-B unit to the summary absorbed dose at an arbitrary point of a tissue equivalent phantom depends considerably on a distance between this point and the center of a source and changes from 2 (for a distance of 0.5 cm) to 1 (for a distance of 10 cm).