Abstract
So far, modern science has failed to provide an exact answer to the issue of the relative role played by genetic and environmental factors in diabetes mellitus type 2 development. This is a survey outlining in a comprehensive manner Hales? ?thrifty? phenotype hypothesis, postulated as early as 1992 as an alternative to the ?thrifty? genotype hypothesis, and as a plausible explanation of the doubtless relationship existing between low birthweight and increased maturity-onset type 2 diabetes morbidity rate. Researches by Barker et al, upsetting the notions on the impact of intrauterine and early postnatal development on the quality of life, and becoming foundation of the hypothesis of intrauterine ?programming? of the commonest diseases in adults ? hypertension, ischemic heart disease, type 2 diabetes, hyperlipidemia and the like ? are given due consideration. Also reference is made to evidence from epidemiologic, family and experimental studies along this line. Studies inconsistent with the hypothesis, as well as recent developments of the ongoing debate in the pertinent literature are briefly discussed. Support is given to Hales? viewpoint on the need of purposeful experiments aimed at gaining better insinght into the relative role of genetic and environmental factors with a view to undertake effective measures for diabetes epidemic control. Till then, maximum preclusion of the known risk factors to which low weight of neonates and infants should be added, is considered as the only adequate theraupeutic approach.

KEY WORDS: type 2 diabetes mellitus, ?thrifty? phenotype, intrauterine programming, insulin resistance.

Abstract

Somatotropic hormone (growth hormone ? GH) is long since considered as the chief carbohydrate metabolism regulator. Its metabolic effects are complex, controversial and still not well enough clarified. Interences thus far reached are based first and foremost on the results of experimental studies and replacement therapy with GH. Its direct effects are usually divided into insulin-like and insulin-antagonistic or diabetogenic ones. The sequels of pathologically sustained GH excess, as seen in acromegaly, differ somewhat from those observed after prolonged exogenous GH uptake. There is a great paucity of data on the single aspects of carbohydrate and lipid metabolism in acromegaly, insofar as studies along this line cover a modest number of patients which in turn does not allow definitive conclusions to be drawn. In general outline the diabetogenic action of GH is prevailing, but interrelations between GH, IGF and insulin have important practical implications and require further researches.

KEY WORDS: growth hormone, acromegaly, carbohydrate metabolism, diabetes mellitus, lipid metabolism, dyslipidemia. 

Abstract

The parameters of left ventricular systolic and diastolic function and left ventricular muscle mass are studied in 32 acromegaly patients, and the obtained results are compared with those in 32 healthy sex and age matched individuals. Standard echocardiography and Doppler-echocardiography are performed using echocardiograph Hewlett-Packard Sonos 1500.
The indicators evaluated include: left ventricular wall thockness, left ventricular end-systolic and end-diastolic size and volume, left ventricular filling index, left atrial, aortic and right ventricular size, acceleration and deceleration time, E peak-to A peak ratio, left ventricular muscle mass. Aortic, mitral and tricuspid valve blood flow assessment is done by color Doppler.
As shown by the results the changes observed involve first and foremost left ventricular systolic function, with diastolic dysfunction being rarely recorded. Aortic regurgitation is documented in 31,0 per cent of patients, mitral regurgitation ? in 46,8 per cent and tricuspid regurgitation ? in 37,5 per cent. In acromegaly patients a statistically significant (p<0,001) increase in left ventricular muscle mass is established.

KEY WORDS: acromegaly, echocar-dio-graphy, Doppler-echocardiography, systolic dysfunction, diastolic dysfunction.

Abstract

The aim of the study is to assay Sulodexide (Vessel Due F) effect on the parameters of radionuclide angiography with 99mTc-MDP in diabetics with peripheral vascular disease. Fifteen patients presenting diabetes type 2 and peripheral macroangiopathy (stage II according to Fontaine) are covered by the study. It is designed as a longitudinal prospective study, undertaken after objaining informed consent and against the background of adequate glycemic control. Sulodexide is administrated im for ten days at dose 600 lipoproteinlipase releasing units (LSU), followed by 500 LSU per os for further 60 days. Before and after treatment, radionuclide angiography with 99mTc-MDP is carried out along with analysis of the angiographic parameters of the perfusion curves. An increase in the amplitude of post-treatment perfusion curves is established. Sulodexide (Vessel Due F) treatment is practicable in the complex theraupetic approach to patients presenting peripheral diabetic macroangiopathy.

KEY WORDS: radionuclide angiography, Sulodexide, diabetes, macroangiopathy.

Abstract

It is the purpose of the study to assay the importance of insulin secretion phases, measured during IVGTT, and anti-GAD65 antibodies as ?-cell autoimmune marker, in making early exact diagnosis of the type of diabetes in normal-weight patients, aged 30?45 years. Forty-two newly diagnosed diabetic patients (25 men and 17 women), at mean age 37,2?6,9 years and BMI 24,4?2,7 kg/m2 are covered by the study. Nineteen subjects with normal glucose tolerance at mean age 36,8?7,4 y and mean BMI 24,3?2,3 kg/m2, serve as controls.  According to data from IVGTT and anti-GAD65 antibodies the diabetic patients are divided up in two groups: type 1 diabetic patients (n=19), showing loss of first (FPIS) and second (SPIS) phases of insulin secretion ? 13,2?5,2 mU/l vs 114,4?41,2 mU/l in the control group (?<0,001), and 15,3?6,5 mU/l vs 63,2?20,1 mU/l in the control group (?<0,001), respectively, as well as high prevalence of anti-GAD65 antibodies ? 73,7%; and type 2 diabetic patients (n=23) demonstrating decline of FPIS ? 25,8?11,3 mU/l (?<0,001 as compared to healthy controls, and ?<0,01 as compared to type 1 diabetic patients, and relatively preserved but retarded second phase insulin response (61,4?17,8 mU/l, ?>0,1 as compared to healthy controls), none of them being anti-GAD65 positive.  IVGTT allows for precise assessment of the insulin secretion phases, and in conjunction with anti-GAD65 antibodies contribute to make exact early diagnosis of the type of diabetes in normal-weight newly diagnosed patients, aged 30?45 years. The approach outlined proves clinically relevant in terms of discrimination between type 1 and type 2 diabetes, and adequate treatment prescription.

KEY WORDS: IVGTT, insulin secretion, anti-GAD65 antibodies, diagnosis, type 1 diabetes, type 2 diabetes.

Abstract

Knowledge of the effect exerted by a wide range of iodine intake on public health in regions without manifest iodine deficiency is rather scarce. Pregnant and breastfeeding women, as well as neonates are groups at risk due to relatively low iodine intake. The flat country characterizing the Varna region, and its closeness to the sea warrant the assumption that iodine intake among the populaion is suffitient. However, clinical manifestations of impaired thyroid function are by no means infrequent ? goiter in school age and adulthood, overt and subclinical hypothyroidism in the population. Since cases of cretenism are not registered and endemy among schoolchildren is unknown, it is natural to pose the query ? What is the iodine status of the community in the seaside region?
The iodine status in 180 pregnant women is studied by the method of Dunn and Gutekunst, using ioduria as a biochmical marker. The median ioduria measured amounts to 56,90 ?g/l. Prospective monitoring of 39 subjects of the total throughout the pregnancy and lactation periods shows elevated iodine deficiency in cases without iodine supplementation, as follows: in the first pregnancy trimester ioduria median amounts to 80,0 ?g/l, in the third trimester ? 45,54 ?g/l, and in the lactation period by the end of the first postpartum year ? 39,44 ?g/l. Thyroid volume shows a 48 per cent increase by the end of the first postpartum year. At termination of the first postnatal year, the increase in thyroid volume points to a positive correlation with TTH and iodine status.

KEY WORDS: goiter, pregnancy, ioduria, iodine deficiency.

Abstract

The Bulgarian League for the Prevention of Osteoporosis launched a mass screening epidemiological examination of osteoporosis in Bulgaria. Six-hundred twenty-seven women aged 38 to 58 years (295 with normal menstrual cycle and 332 postmenopausal) from 3 major cities (Sofia, Bourgas and Blagoevgrad) are covered by the study. Of them 40,5% are with university education, 57% ? seco-n-dary and 2,5% ? elementary. A campaign for free-of-charge bone density measurement is announced, and the subjects being examined fill in an individual questionnare, with special attention focuced on factors such as diet, motor activity and harmful habits.
Reduced bone mineral density (BMD) is found in 42,8% (n=269) of the subjects under study, and in 8,9% of them (n=24) the risk of sustaining fractures is increased. There is a negative correlation between ?-score and age, ?-score and number of pregnancies and births, and ?-score and menopause duration (?<0,001). Of those with reduced BMD 62,8% consume milk rarely or never (?<0,001). A significant negative correlation is present between  ?-score and quantity of coffee consumed on a daily basis (?<0,01). Hardly 33% of Bulgarian women consume moderate amounts of alcohol beverages ? up to 100 ml wine or 50 ml hard drinks. One half of the subjects under study are smokers. As shown by the findings, 38,9% of the latter smoke 20 or more cigarettes daily. The physical activity level among Bulgarian women is very low to nil. Only 3 of the women inquired (0,47%) practice some kind of sport, while 52,5% perform no exercises whatsoever.
Conclusion: A number of aspects of the lifestyle in middle-aged bulgarian women (milk, coffee, alcohol consumption, smoking and physical activity as well) are assayed in an attempt to demonstrate the correlation existing between them and bone mineral density.

KEY WORDS: menopause. reduced bone mineral density, lifestyle.