The article is devoted to the study of morphological changes of the adrenal glands in arterial hyperten-sion. Adrenals investigated persons who do not suffer in life and suffering from hypertension during the life of hypertension and died from various causes – is incompatible with the life of a mechanical trauma, cerebral hemorrhage, and acute left ventricular failure. In each case, each of the adrenal glands were assessed: the presence and severity of focal and diffuse mononuclear infiltration, the number of lympho-cytes, monocytes, plasma cells and fibroblasts arranged in the respective zones of the cortex and medulla, the severity of hyperemia and edema of various structural parts, the number of zones cortex and medulla endocrinocytes with pycnotic nuclei in the reticular zone evaluated the distribution of secretory cells with lipofuscin and the degree of saturation of the cytoplasm of the secretory cells, in secretory cells of medul-la evaluated nuclear-cytoplasmic ratio, the severity of vacuolization and basophils cytoplasm revealed a number of regularities of morphological changes depending from the various clinical manifestations of hypertension, defining the ultimate option of dying. At the heart tanatogenesis version are more pro-nounced morphological features hyperfunctions glomerular zone – namely delipidization left and right glands. The beam and netted areas contralateral glands embodiment of dying of a heart compared to the brain, is more pronounced hyperemia. When cardiac variant tanatogenesis more pronounced focal lym-phoid infiltration and vacuolization in secretory cells of left adrenal medulla.

The purpose of the study. To examine the contribution of diabetes and obesity in the development of pulmonary embolism on the based data of the Register of new hospital of pulmonary embolism (PE) in hospitals inTomsk(2003–2012). Material and Methods. The medical history and records of autopsies of patients treated in hospitals in the city ofTomsk, 2003–2012, and anatomopathological and/or instrumental examination revealed pulmonary embolism have been subjected to studies. We used the classification of diabetes mellitus proposed by the WHO in1999 inour work, because the register including data (2003–2012). The degree of obesity was assessed according to WHO classification (1997). Statistical analysis of the results was carried out with the help of software for computer Statistica for Windows, version 8.0. The Shapiro–Wilk and Kolmogorov–Smirnov tests was used to determine the nature of the distribution of the data. The ho mogeneity of the population variance was assessed using Fisher's exact test andLeuventest. The Mann– Whitney test was used when comparing two independent samples to determine the significance of differences. The analysis was conducted by means of qualitative characteristics contingency tables using Pearson χ 2 . The odds ratio was calculated to assess the association between a specific outcome and the risk. Data are presented as M ± SD factor. The significance level of p for all procedures used by the statistical analysis was taken to be 0.05. It was considered statistically significant level of p < 0.05. The results of the study. In intermediate urbanized city ofWestern Siberia,Tomsk, established register of hospital pulmonary embolism (2003–2012). The register included 751patients whose in vivo and / or postmortem revealed pulmonary embolism (PE). The data histories and autopsy reports was analyze. The type 2diabetes was diagnosed in 205 patients. The type 2 diabetes moderate had 29%. Diabetes severe suffer 82 patients (40%). In the group body mass index (BMI) was (29.24 ± 7.87) kg/m2 . Obesity diagnosed in 157patients (20.9%). It occurs in24.7% of cases for women andin 15.2% of cases for men. If a patient had obesity grade 3 was found to increase the risk of a massive thromboembolism in 3.27 times (OR = 3.27; 95% confidence interval [1.60–6.69]; p = 0.001) and an increase in the risk of fatal thromboembolism 3.56 times(OR = 3.56; 95% CI [1.73–7.43]; p = 0.001). It does not detect the influence of obesity 1 and 2 degrees on the development of a massive pulmonary embolism, or PE, which would cause the patient's death. Significant effect of type 2 diabetes was found on the development of the heavy flow of fatal pulmonary embolism. 

This study was aimed to determine peculiarities in regimens of the pump insulin therapy and to reveal the optimal basal-to-bolus insulin ratio that are necessary for achieving optimal glycemic control in adoles-cents with type 1 diabetes mellitus (T1DM).  82 adolescents at the age of 14–18 with T1DM, using continuous subcutaneous insulin infusion (CSII) from 5 months to 7.5 years were monitored with continuous glucose monitoring (CGM) system «Guar-dian Real Time» or CGM system, built in MiniMed Paradigm Revel System 722 (Medtronic Minimed, USA). Assessing the quality of glycaemic control was based on the level of glycated haemoglobin (HbA1c). The results of CGM were reviewed and average for 3 days performances: total daily dose of insulin, dose of basal and bolus insulin, basal-to-bolus insulin ratio, carbohydrate content of the meal, expressed in BE, carbohydrate ratio, insulin sensitivity factor were determined. The patients were subdivided into 2 groups: group 1 – adolescents with the optimal/suboptimal glycemic control (n = 55), 2 – adolescents with long-standing poorly controlled T1DM (n = 27). Average total daily dose of basal insulin (U in a day, U per kg in a day) in adolescents group 1 was significantly higher, com-pared with patients in group 2 (р = 0.043; р = 0.038 respectively). Patients in group 2 received more car-bohydrates with a meal intake and had higher doses of average total daily bolus insulin. The average ba-sal-to-bolus ratio from group 1 patients was 51/49%, compared with group 2 patients – 45/55% (р = 0.026).  An important condition for achieving optimal glycemic control is a high level of compliance and skills of adolescents. Optimal well-balanced basal-to-bolus insulin ratio in adolescents with T1DM on CSII, which can provide improvements in blood glucose management and reducing the risk of complications of the disease, is 51/49%. 

The results of analysis of cardiovascular and psychosocial risk factors which influence the development and prediction of ischemic heart disease (IHD) and disorders of carbohydrate and lipid metabolism in 132 patients with neurotic and affective disorders are presented. The significance of predictors of IHD formation was evaluated with method of logistic regression. According to results of stepwise procedure the total score of prediction of IHD in male group was 93.7%. The influence of mental factors on disorders of carbohydrate and lipid metabolism which lead to persistent rise of level of blood glucose, lipid spectrum indices imbalance, promoting the progression of cardiovascular risk in IHD patients with anxiety, depressive, asthenic and other non-psychotic mental disorders, was ascertained.

Socio-hygienic assessment of the health of students inTomskfor the period from 2007 to 2009 helped identify negative trends in the incidence of endocrine disorders that require improved technology organization providing medical and preventive care. The results of the analysis of the effect of risk factors on the development of the endocrine pathology among students possible to determine the need for and develop a system of sanitary measures, the implementation of which helps reduce the risk of endocrine diseases and improve preventive work among the students of Tomsk. 

The article presents results of bone kists treatment by porous granular titanium nikelid materials and dynamic of osteokalcin. A comparative examination with standard treatment technology group demonstrated high efficiency of a proposed method. Porous granular titanium nikelid materials possess mechanical strength, optimization of regeneration at the expense of osteoinductivity by osteokalcin and allow you to effectively fill the cavity with a complex anatomical structure. 

Disorders of sex development with Y chromosome material has been associated with a high risk for developing germ cell tumors such as gonadoblastoma or dysgerminoma. The aim of the study was to investigate the risk of germ cell tumors in patients with XY gonadal dysgenesis. Material and methods. In the study included 11 patients with XY gonadal dysgenesis: 4 with complete gonadal dysgenesis and 4 with partial gonadal dysgenesis. Results. Pathologic examination revealed gonadoblastoma and dysgerminoma with gonadoblastoma in 2 of 9 (22%) patients (who had gonadectomy), including 2 of 3 patients (66 %) with complete gonadal dysgenesis. In our series of patients with gonadal dysgenesis 46,XY the risk of germ cell tumors was high, especially in patients with complete gonadal dysgenesis. Considering this results, early gonadectomy is strongly recommended in females patients. The patients with partial dysgenesis with scrotal gonads being reared as males need monitoring. 

Objective. To estimate the correction failure 25 (OH) D in patients with polycystic ovary syndrome.
Material and Methods. The study involved 44 patients with polycystic ovary syndrome, aged 31.32 ± 5.05, who were randomly assigned to 2 groups: 1st – obtained coca biguanides and Kolekaltsiferol, second – combined oral contraceptive (combined hormonal ) and biguanides. The comparison group consisted of 22 healthy women matched for age and sex. Polycystic Ovarian Syndrome (PCOS) was verified on the
Оригинальные статьи
Бюллетень сибирской медицины, 2015, том 14, № 5, с. 47–53 53
basis of diagnostic criteria ESHRE / ASRM (2012). 25 (OH) vitamin D was determined by enzyme-linked immunosorbent assay (ELISA ng/ml). Examined glucose and fasting insulin, HOMA index of insulin re-sistance. Depression was assessed using the Beck test. Statistical analysis – R-system.
Results. The patients with PCOS defined by the expression deficit of 25 (OH) D, which is associated with hyperandrogenism, hyperglycemia, hyperinsulinemia, insulin resistance, as well as depression. Ad-mission kolekaltsiferola leads to improved glucose metabolism and manifestations of PCOS, and also significantly reduces the parameters of OT, OT / OB, depression.
Conclusion. Failure correction of 25 (OH) D contributes to the improvement of metabolic and psycho-logical parameters of fertility.

For today the question of early diagnosis of nosological variants, the method of treatment and prevention of nodular goiter in children is still not fully resolved. There is a few available literature data about study of this problem in children. Objective: to study morphofunctional structure of thyroid nodules in children.

The article provides information consisting of the results of a retrospective analysis of case histories of 73 patients, operated with nodular goiter in Z.A. Bashlyaeva Children’sCityClinicalHospital(Moscow) from 2003 to May 2015. The examination included an evaluation of the functional status of the pituitary-thyroid system: there were investigated serum thyroxine, triiodothyronine and thyroid stimulating hor-mone, also was performed thyroid scintigraphy 99mТc. In the postoperative period, there was carried out a final verification of the diagnosis according to the results of the histological conclusion. The histologi-cal type of nodal disease was defined by the WHO classification of 2004. It was established that in the structure of a single-node goiter in children prevail nodular colloid goiter with equal frequency in boys and girls, with the same frequency occurs thyroid adenoma, but more often in girls than in boys. The multinodular goiter equally often detected in girls and boys both nodular goiter colloidal with varying degree of proliferation and colloid in combination with follicular thyroid adenoma. "Hot" nodes in the multinodular goiter are more common than in the single-node goiter and more fre-quently in girls than in boys. The half of children with nodular pathology have "hot" nodes and one out of every three – decompensated form of functional autonomy. Decompensated form of functional autonomy of the thyroid gland in children with "hot" nodes detects regardless of the number of nodes. Papillary thyroid cancer occurs not only in patients with a single-node, but with a multinodular goiter. The results allow to draw conclusions about the heterogeneity of the morphological structure as a single-node and multinodular goiter in children, including papillary thyroid cancer. 

The aim of this work was to study the levels of the heart fatty acid-binding protein (h-FABP), interleukin6 (IL-6) and interleukin-8 (IL-8), in diabetic nephropathy (DN) in patients with type 1 diabetes mellitus (T1DM). Material and methods. We examined 87 patients aged 18 to 54 with T1DM within the study group. 30 patients with type 1 diabetes were diagnosed with normoalbuminuria, 29 patients – with microalbuminuria and 28 patients – with proteinuria. The control group consisted of 24 healthy donor aged 22 to 29. The comparison group included 22 patients aged 20 to 42 with verified diagnosis of essential arterial hypertension (AH) without carbohydrate metabolism disorders. The daily urinary albumin excretion was determined by immunoturbidimetric technique. 30 patients with type 1 diabetes were diagnosed with normoalbuminuria, 29 patients – with microalbuminuria and 28 patients with proteinuria.Calculation of glomerular filtration rate was performed according to the Hoek formula with the use of cystatinС serum concentrations. Contents of h-FABP, IL-6 and cystatin C in serum and h-FABP, IL-8 inurine were determined by enzyme-linked immunosorbent assay. Results. Analysis of the h-FABP content in serum showed that the concentration of this marker in individuals with T1DM was higher than in patients of the control group and the comparison group. Analysis of the h-FABP content in the urine revealed that individuals with essential hypertension showed an increased level of h-FABP while patients with T1DM demonstrated the highest concentration of h-FABP. The concentration of IL-6 inindividuals with T1DM and in individuals with AH significantly exceeded the control values. The contents of h-FABP and IL-6 inserum and h-FABP and IL-8 inurine increased with the progression of DN and reached maximum in individuals of the proteinuria subgroup. At the same time, the levels of h-FABP and IL-8 inthe urine of patients in the microalbuminuria (MAU) subgroup were higher compared to those in individuals of the normoalbuminuria (NAU) subgroup. Noteworthy is the fact that the h-FABP content in the urine of individuals in NAU subgroup was higher compared to the control group. Furthermore, higher rates of h-FABP and IL-8 urinary excretions were observed in individuals with CKD stage 2 as compared to individuals with CKD stage1 inthe MAU subgroup. Conclusion. Thus, the results obtained in the course of the study indicate that h-FABP and IL-8 can be considered as alternative markers of DN progression in patients with T1DM. 

Relevance. Through dermal coronary intravascular revascularization by means of stenting is an effective method of treatment CHD patients with the type 2 diabets. At the same time frequency of stents restenosing for this special cohort of patients is fluctuating from 12 by 40 %.

Objective. To study prognostic significance of the new biomarker of intravascular inflammation of resisin in blood of CHD patients with DM 2 who suffered from stenting. Material and methods. In the study 60 patients (48 men and 12 women, in the middle age 60.9 years) with CHD and DM2 are included. The patients were divided into two groups: Patients with positive progress of comorbide pathology belonged to the first group (n = 30); in the second group (n =3 0) patients with unfavorable progress of cardiac vessel pathology were included. The further observation was carried during 12 months. Content of all the patients in blood of resistin with help of enzyme immunoassay analysis was determined, as well as lipid blood serum mixture and additional metabolic risk factors. By the indications control a coronary angiography was conducted. Restenosis of coronary arteries was counted as the narrowing of a coronal artery lumen of ≥70% in the place of an intervention.

The result. Unfavorable flow, including restenosis of coronary arteries was revealed in 30 cases (50%). ROC-analysis showed great predictive significance of resistin – (area under a curve >5/35, Sensitivity 86.2, Specificit 70.0) in development of constrictive coronary atherosclerosis restenosis of coronary arteries after their stenosis.

The conclusion. The study of resistin level in DM patients blood for the valuation of the disease prognosis and optimization of the tactics for choice of coronary pathology treatment seems expedient and informative. 

The aim of the study was to evaluatetheglycemic control dynamics depending on degree of blood pressure (BP) reduction and dynamic of TNF-α after 6 and 12 months of Tran catheter renal denervation (TRD) of patients with true resistant hypertension (RH) and type 2 diabetes mellitus (T2DM). Material and methods. Thirty two essentially hypertensive patients with type 2 diabetes mellitus (T2DM) and resistant hypertension were included in single-arm prospective interventional study. Office BP measurement, ambulatory 24-h BP, renal Doppler ultrasound and assessment of renal function (proteinuria, creatinine, eGFR), HbА1c and fasting plasma glucose (FPG) levels, activity of TNF-α were performed at baseline and 6 and 12 months after TRD. On average, patients were taking 4 (3–6) antihypertensive drugs. None of the patients changed the antihypertensive treatments during follow-up. A 6 months follow-up was completed by 27 patients (43–75 years old, 14 male), 12 months follow-up was completed by 26 patients. Results. Renal denervation significantly reduced the systolic office BP (SBP) as well as 24-h SBP (– 27.2/–10.7 mm Hg and–13.4/–10 mm Hg, respectively, p < 0.01 after 6-month follow-up, and –31,7/–12,8 mmHg and –13.4/–10 mm Hg, respectively, p < 0.01 after 12-month follow-up) without any negative effect on renal function. The number of responders with reduction of SBP >10 mmHg according to ABPM were 56% (15/27) after 6-month and 61.5% (16/26) after 12-month follow-up. There were significant reduction of the average HbA1c levels (from (6.9 ± 1.8)% to (5.8 ± 1.5)%, p = 0.04) and nonsignificant decreasing of FPG levels (from 8.7 ± 2.8 to 7.7 ± 2.1 mmol/L, p = 0.07) after 6-month followup. Conspicuously, the responders according to ABPM had significantly higher mean dynamics of HbA1c than the non-responders after 6-month follow-up (–2.4 ± 1.9 and –0.1 ± 0.8%, p = 0.02, respectively) as well as after 12-month follow-up (–0.12 ± 0.98 and 1,26 ± 1.11%, p = 0.04 for HbA1c, and – 0.89 ± 1.9 и 0.85 mmol/L ± 1.19, p = 0.02 for FPG levels). There were significant decreasing of TNF-α after 12-monthfollow-up (from 2.21 (1.54–3.65) to 1.4 (1.11–1.47pg/ml), p = 0.007), without relation to BP and HbA1c dynamics, and response to TRD. There were not the correlations between dynamics of HbA1c and FPG levels with BP reduction and change of TNF-α after 12-month follow-up. Conclusions. Renal denervation of patients with true resistant hypertension and diabetes mellitus type 2 after 6 and 12 months was followed by improved glycemic control, BP reduction and decreasing of mean levels of TNF-α. Glycemic control improvement after the renal denervation was more expressive in the responders. 

Objective. To determine predictors of complications of myocardial infarction (MI) in patients with type 2 diabetes (2TDM) and it’s value of intensive glycemic control during insulin infusion.
Methods. The study included 112 patients with MI and 2TDM at first day of hospital admission with blood glucose level above 7.8 mmol/l. Prognosis of combined study endpoint included the death and ma-jor complications of MI for the hospital and long-term (6-month) stages. The statistical analysis was per-formed (Statistica 6.0 for Windows). The predictive value was assessed with ROC-curves analysis meth-od.
Results. Intensive glycemic control with insulin infusion reduced the activity of lipid peroxidation and improve prediction of study endpoint. Predictors of adverse hospital prognosis of MI in association with type 2 diabetes were hyperglycemia on admission above 10 mmol/l, and increase of C-peptide. The in-crease of C-peptide in the 1st and 7th day, hs-CRP on day 1, diene conjugates on the 7th day and glucose level on admission above 8.9 mmol/l (patients without 2TDM) and 14.3 mmol/l (patients with 2TDM) had the 6-month predictive value.
Conclusion. The strict achievement of the target level of glucose in acute MI improves it’s prognosis at the hospital and at a 6-month prospective study.

The aim of the research was to study the characteristic properties of hemostasia system of children suffer-ing from metabolic syndrome (MS) and exogenous obesity.

Material and methods, A total of 58 children and adolescents aged from 9 to 16 with different stages of obesity. The examined were divided into two groups – the main group including children with MS (n = 33) and the control group including patients with exogenous obesity but without any indications of (n = 25). The presence of obesity was stated according to the criteria described by L.V. Kozlova and her co-authors (2008). All the examined patients had a biochemical blood analysis that included component determination of hemostasia system. The component determination was to reflect all the links of blood coagulation, so the following indices were analysed – activated partial thromboplastin time (A-PPT), prothrombin time (PTT), prothrombin ratio, level of fibrinogen, thrombin time, international normalized ratio (INR) and thrombocyte aggregation with ristomycin.

Results. The children suffering from MS compared with the children without this syndrome had signifi-cantly higher level of prothrombin time, thrombocyte aggregation with ristomycin as well as INR. The index of thrombocyte aggregation with ristomycin in the main group was not only higher than in the con-trol group but also exceeded the reference value. The boys with MS had a notably higher index of throm-bocyte aggregation with ristomycin than the boys suffering fron obesity. The girls with MS had a higher INR factor than the group of girls with obesity.

Conclusions. The research showed that with children suffering from MS their hemostatic system gets involved in the pathological process. The discovered peculiarities show inclination to hyper-coagulation 

Type 1 diabetes mellitus (T1DM) is now widely distributed worldwide and in theRussian Federation, it is an important medical and social problem in connection with the development of serious, disabling complications. Some of these complications could make changes in the brain which are accompanied by cognitive impairments that decrease quality of life and worsening disease compensation. The diagnosis of these disorders to date, possible by using modern methods of magnetic resonance imaging, which describe not only the morphological changes of the brain, but also the metabolism of nervous tissue. The study of the brain, namely structural and metabolic manifestations of diabetes, is one of the priority problem of modern medical science.

The aim of the study was to evaluate dynamics in the different techniques of magnetic resonance imaging in the diagnosis of brain changes in patients with T1DM.

Research methods included physical examination, in accordance with the diagnostic algorithm of patients with T1DM, a neurologist consultation, an assessment of cognitive function, analysis of brain changes using standard magnetic resonance imaging and spectroscopy. Statistical processing was performed using software package R-system. This publication presents a clinical case of a patient with T1DM and severe cognitive impairments are associated with changes in the brain, diagnosed using standard magnetic resonance imaging and spectroscopy. The study shows the positive role of correction of carbohydrate metabolism in improving cognitive function in a patient with T1DM.

In addition, the process analysis revealed the absence of dynamic changes in the brain of a patient with T1DM according to standard magnetic resonance imaging. This required the use of additional techniques – magnetic resonance spectroscopy, which revealed changes of metabolism in the thalamus N-acetyl aspartate, choline and creatinine.