V. Koivisto

Insulin lispro is a rapid acting insulin analogue, which has been recently developed particularly for mealtime therapy to be injected immediately before the meal. It has a fast absorption rate and a short duration of action. Current data indicate that as compared to human regular insulin, the optimal use of insulin lispro offers the potential to improve postprandial and long-term hyperglycemia. In addition, insulin lispro can reduce nocturnal hypoglycemia and the rate of severe hypoglycemia in type 1 diabetic patients, and improve metabolic control without an increase in the hypoglycemia rate. The patient satisfaction is greater with insulin lispro as compared to human regular insulin - over 70% of patients prefer insulin lispro. The major reason for a better satisfaction is greater flexibility, a possibility to inject the insulin immediately before the meal. 
 

Key words: type 1 diabetes, Insulin   lispro, hypoglicemia 
 

Ph. Kumanov
 

Unlike in women there is no abrupt end of the reproductive capacity of men. Rather a progressive decline of androgen production and some decrease of spermatogenic function are observed with ageing. Therefore, the andropause does not exist. Partial androgen deficiency of the ageing male (PADAM) seems to be a more appropriate term for the period following young reproductive age.

One of the most important complaints associated with ageing is the erectile disfunction, but age-related chronic diseases, the use or the abuse of various medicines, as well as socioeconomical and physiological factors have a consi-
derable influence on the sexual functioning.

Risks, especially for the prostate gland and cardiovascular system, and benefits of testosterone supplementation in older males should be clarified in the near future after the careful interpretation of the results from controlled prospective studies.
 

Key words: andropause, PADAM, total testosterone, erectile disfunction, ageing.
 

Z. Kamenov, M. Orbetzova, V. Christov, M. Andreeva
 

Late-onset adrenal hyperplasia (LOAH) is the most common autosomal recessive disorder in the human. Partial 21-hydroxylase deficiency accounts for the vast majority of LOAH, but deficiencies in 11b-hydroxylase and 3b-hydro-xysteroid dehydrogenase may also result in the disorder. These forms exhibit a great polymorphism in their clinical expression (variation in age at appearance and in degree of hyperandrogenism, and an association with abnormalities of the menstrual cycle). The incidence among women with clinical signs of hyperandrogenism varies from 1% to 35%. At present the only standard diagnostic criterion for LOAH with 21-hydroxylase deficiency is the level of 17-hydroxy progesterone after acute ACTH-sti-mulation. HLA-typing and purposeful genetic analysis advance the diagnosis. There is not any generally accepted approach for the diagnosis of the other two deffects. The correct diagnose of LOAH determines the therapeutical measures and follow-up of the patients.
 

Key words:  hyperandrogenism, congenital adrenal hyperplasia, late-onset adrenal hyperplasia, ACTH-test.
 

H. Bohchelian, L. Koeva
 

The aim of the study is the identification of the risk for complicated diabetic foot. A case - control study is carried out. The object of investigation are 182 type 1 and 2 diabetics subdivided into two groups: group A (cases) – 42 patients with present and former foot ulce-ration; group B (controls) – 140 diabetics without ulceration. The degree of control and diabetic complications are assessed. Blood glucose level, HbA1c, lipid profile are investigated. Osteodensitometry, electromyography, x-ray and isotopic investigation of the feet are carried out. The ulcerative risk in the two groups is analysed. Data are obtained, that poor diabetic control, chronic diabetic complications and osteopenia are predictors for foot ulceration. Osteometry could be one of obligatory investigations in assessment of diabetic control. Bone density measurement is necessary for early diagnosis and prevention of diabetic foot complications.

Key words:  diabetic foot, foot ulceration, risk factors.
 

M. Velkov, Iv. Mendizov, G. Dashev
 

The study group included 61 patients with recurrent thyroid diseases reoperated twice in the Clinic of Endocrine Surgery for the period 1985 – 1996. The distribution according to sex and age included 8 males aged from 17 to 59 (39.6 years average age) and 53 females aged from 15 to 73 (42.7 years average age).

All patients were reoperated by reason of the following diseases: nodular recurrent goiter – 42 cases, recurrent Hashimoto thyroiditis – 1 case, recurrent Graves’ disease – 2 cases, recurrent multifocal thyroidal autonomy – 4 cases, alien corpuscle – 3 cases, regional lymphogland metastases from thyroid carcinoma – 8 cases, secondary thyroidectomy – 1 case.
The aim of the study was to analyse the characteristics of secondary thyroid recurrences, the appearance period after the second surgery in connection to the extent of reoperation, hormone replacement therapy and family history.

The pathomorphological investigation of all hystological specimen was made parallel with the clinical study. Its aim was to establish the morphological substrate of the secondary thyroid recurrences and to create some individual criteria in respect to different recurrent thyroid diseases. The appearance period of second recurrences concerning the patients with nodular recurrent goiter was up to 6 months in 9 cases, up to 1 year in 9 cases and up to 5 years in 15 cases. 35 out of 61 patients had pseudo-recurrence (57.37%). Prophylaxis with thyroid hormones was applied only in 15 patients (24,59%). Family predisposition was established in 10 cases (16.39%). 

Morphological signs in the primary operative findings as prevalance of microfollicles, presence of micronodules, secondary papilliferity, stronger proloferative reaction of the folicular structures appeared very important markers for the persisting process in the thyroid. The possibility for a recurrent development in these cases seemed extremely high.

Key words: thyroid recurrence, reoperation, pathomorphological investigation, hormone therapy.